Published on 12, July, 2020
Hi Everyone,
I was diagnosed about 6 months and the one thing I get really confused by is the lack of consistent approach to diagnosis and the methods used.
My diagnosis consisted of 2 parts, ADOS performed by a speech and language therapist and ADI by a psychiatrist - my wife was my informant,
On my assessment report it says that to get a successful clinical Autism diagnosis you must meet the criteria of both ADI and ADOS and the assessment must be carried out by a multi discipline assessment team with all disciplines being in agreement. Since my diagnosis I have heard from other Autistic People about their diagnosis process and confused how other clinics (including some NHS trusts) assess with only a single psychologist using ADI style questioning (i am actually really jealous about this as I found ADOS very stressful and left me burnt out for about a week). I wonder if anyone can offer an explanation for the differing requirements for successful assessment? It was suggested to me that it might be because my assessment covers both NICE and DSM requirements but not sure if this is correct or not?
Also wondering if there was impact on support when receiving differing diagnosis. I do know someone in my Autism support group that was refused by Access to work support for reasonable adjustments when starting a new job. Their Autism assessment was performed by the NHS and appears it wasn't accepted as sufficient.
i get the feeling it can be a bit of a lottery how the assessment and follow up support process plays out, but its one of the things that really keeps nagging at me and won't go away until I have recieved an explanation, so really hope some one can shed some light on it :-)
Grogu's Dad said:On my assessment report it says that to get a successful clinical Autism diagnosis you must meet the criteria of both ADI and ADOS and the assessment must be carried out by a multi discipline assessment team with all disciplines being in agreement.
Well, this is factually wrong. That is just some clinicians thinking that their approach is the best, but extending that idea - wrongly - to become "All other approaches are invalid".
Taken verbatim from the NICE guidelines for the assessment of ASD, "Diagnostic assessment, which in the UK uses ICD-10, is often within a multi-disciplinary team but at a minimum is by a qualified clinician, usually a clinical psychologist, psychiatrist or neurologist." From the document: Autism Recognition, referral, diagnosis and management of adults on the autism spectrum, National Clinical Guideline Number 142, p. 25.
I think there is a welter of problems regarding diagnosis and support. The NHS seem to have chosen the most long-winded and expensive method of making adult autism diagnosis. Firstly, it seems to be based on that used for children, with very little modification for application to adults. Secondly, it involves a team of clinicians and takes a long time, therefore it is expensive and allows ridiculous backlogs to build up. This has been recognised by the NHS increasingly paying for private assessments that are quicker and often employ only one, suitably qualified, clinician (the 'Right to Choose' scheme).
Many employers, local governments, social services and educational institutions etc. have no idea what constitutes a valid autism diagnosis and entirely wrongly deny people support that they are fully entitled to. Very often some incompetent pen-pusher makes up erroneous rules, unfortunately, they are not often challenged, as they ought to be.
CG 142 guidance dated June 21 paragraph 1.2.5 actually says a comprehensive assessment SHOULD be team based and draw on a range of professional skills.
The important word here is 'should' and its legal definition which is an advisory term and not a mandatory term like 'will' and 'shall'.
its is very easy to see why some clinics particularly private ones will interpret this as mandatory. As they avoid any potential issues at a later date if someone appeal a diagnosis result.
I am not sure i would say its factually wrong either as it probably how their lawyers haver interpreted the guidance to avoid future liability
I would disagree. If something is not necessary, merely a recommendation, it remains not necessary. It does not become 'quasi-necessary'.
The main problem is that the team-based approach is proving unworkable, leading to waiting times for autism assessment of over two years in some areas. Whereas the intensive, multi-clinician team approach is probably necessary for the diagnosis of young children, for adults who are fully capable of describing their traits and experiences, it is a ridiculous level of overkill. This is particularly so because being a diagnosed adult usually leads to no meaningful support. Clinicians doing autism assessments of adults are not gatekeeping an El Dorado of financial benefits.