What's An Assessment Like?

My assessment took place in the UK using DSM-5, and ADOS 2 to observe behaviours during standardised activities. Face to face assessments give the clinician a chance to observe a wide range of behaviours. I can’t add much additional information to the comments here, except to say don’t worry if you forget to include something, the clinicians will be looking at more than your answers. It is much more important to be yourself, whether or not you inadvertently mask. They certainly won’t put you under duress to find a ‘correct’ answer. 

I have no knowledge of the autism assessment process in Lithuania, but I can vouch for the expertise and excellent care I received following orthopaedic surgery a few years ago.

Some third parties working with the NHS use the DSM 5 like psychiatry UK

The initial session is to see if it is worth doing the formal assessment. It saves people time and money if they are mistaken. It is also to see if you have a rationale for doing it.

In my case they told me at the end they didn't just think it was worth progressing, they largely decided in that session, the formal stuff was just to confirm it. I'd asked then when they knew, expecting them to say it was a bit marginal.

This is so helpful! Thank you. 

I already had an interview, which seemed along the lines of an assessment, really, as the therapist went down a list of checkpoint-type elements, and proposed to me theoretical situations. When I gave those answers more than a month ago, I had much less conscious awareness of my condition; in the meantime, all sorts of things have popped up. It feels like the moment when you learn a new word, and suddenly you see it in advertisements or announcements all around you in familiar places. It was always there, but it had no meaning because you did not know it. 

I would answer some of those questions differently now, so I understand the reason your session gave you time to answer. In essence, that's what they're doing now. They had an initial assessment/interview, then told me they suspect autism but require a more thorough assessment, done by a different specialist, with whom I've yet to speak. My take on a question like, "What do you notice when you watch characters having a conversation in a film or television show," is completely different. In fact, I try to memorize the back-and-forth, and the difference between what they would say and what I would say, given certain questions. 

What's fascinating is just how much of my day-to-day and moment-to-moment is different now. Yesterday, the vibrations of the shopping cart I was pushing over an asphalt car park made my entire body tense, and my hands felt like they were burning. What...I used to just ignore that? It's frightening and fascinating and just downright weird. 

ICD 11

My assessment was done under ICD 11 and the report has several tables of information consisting of :

Development/Personal History

Evidence of impairment

Health Relate Areas

Mental Health Comorbidities

Neurodevelopmental Comorbidities

Substance Use and Smoking Status

Risk assessment - Past and current

ADI-R Summary of Findings

ADOS Assessment

Then there is a table of "ICD-11 Autism Spectrum Disorder Checklist" where the result for each trait is yes/no/some traits.

It says at the top of the table "Must meet criteria A,B,C, and D", then there are 7 traits for criteria A, 7 traits for criteria B, one trait for criteria C and one trait of criteria D.  The columns of the tables are ADOS-2, ADI-R, MDT and Overall.  At the bottom of the table is the question "Are the diagnostic criteria of Autism Spectrum Disorder met?

After that there is a section whether an Intellectual Development disorder is present or not, then whether an Impairment of Functional Language is present or not.

The outcome of my assessment lists the members of the multidisciplinary team and states that they agree that I meet the criteria for Autism Spectrum Disorder under ICD-11.

DSM 5-TR

i don't know what a DSM5-TR assessment report looks like, but having a look at my copy of DSM5 (where the autism section is almost identical to DSM5-TR)  it looks like the outcome will record in addition to specifying whether an intellectual impairment is present or not and whether a language impairment is present or not it is required to specify the support level required for "social communication" and for "Restricted, repetitive behaviors", with the levels being:

Level 1 "Requiring support"

Level 2 "Requiring substantial support"

Level 3 "Requiring very substantial support"

Maybe someone having an assessment under DSM 5-TR would have more information on the differences between the two in terms of the report that you receive and will be able to provide more information.

Edit: I found this example of a DSM 5 assessment report that is very different from the ICD 11 one I had (The ICD 11 assessment seems to be whether you have traits or not and DSM 5 gives scores where traits are present):

www.registeredpsychologist.com.au/.../PECS-Example-Autism-Report.pdf

If it is anything like what I did:

There will probably be some forms to fill in advance. Some are the screenimg tests, some are personal detail related. One of my forms covered questions related to autistic traits. I took 1-2 weeks to fill this in as I thought of things. I researched things online, then thought back to find evidence, which took time. I don't know how common this is but it removes the pressure to try to remember stuff as they have read it all in advance.

You have one or more sessions. I had one to talk about my life and background in general, and one about the autistic traits. They clarified any points from the answers I supplied and I could raise anything else.

The sessions were steered conversations, not an interview. They stop you from rambling, or going off topic and wandering into special interests.

I also did the ADOS-2 test, which is a session with a behavioural expert, you do some simple tasks and talk a bit about your life.

There is no pass or fail. I think it may be  possible to fake being normal if you are good at masking and wanted to, but you need to just relax and be yourself, I think it is harder to fake being ASD. They look for consistency, it is about what you don't say, how you phrase things, what you talk about, not just claiming to have some traits. It is better to all be done face to face.

I thought I had done too well and might just be a quirky worried normal person. But they'd though I was positive from the initial discussion before we even started.

How they handle absence of an informant is up to them, it should be possible, you should ask.

There shouldn't be anything confrontational or awkward. They should want you to be at ease and talk. But I don't know Lithuania.

Criteria and Tools used in an Autism assessment:

https://www.autism.org.uk/advice-and-guidance/topics/diagnosis/assessment-and-diagnosis/criteria-and-tools-used-in-an-autism-assessment#ICD-11%20criteria%20for%20autism

ICD-11:

https://icd.who.int/browse/2024-01/mms/en#437815624

DSM-5:

The DSM-5 is not published publicly online as this is a purchase-only manual principally designed for clinicians

The actual result of the diagnosis will be different depending on which system is used e.g. you don't get a severity level of 1 to 3 with ICD 11, but you do with DSM 5-TR.

I think I can get both of those in my local library. Thank you. 

In the UK they give you results with reference to ICD-11, as the American Psychological  Society use DSM 5-TR if you need the result for anything other than personal interest it might be worth checking if the diagnosis is available with reference to DSM 5-TR or if whatever you want the assessment for is acceptable with reference to ICD-11.

I understand, the psychiatrist will possibly be looking at how you answer/interpret questions, your tone of voice, eye contact, facial expressions or lack of. These are some of the areas of assessment that came up on my report.

Also, Literal_Joe , that's a great handle. 

There are quite a few autistic people from the UK who have YouTube channels, and I've been following them. It seems to me that, regarding the identification and aid of neurodivergent people, the UK is much further along than many places in the world. It's refreshing. I have a feeling the Lithuanians base their procedures on places in the EU (and the UK...still sad about Brexit), so I should expect what you're describing is analogous.  

I had done some of it before the original consultation to determine if I should be assessed. The therapist was very interested in it and said I had actually done a portion of the assessment already.

My assessment was based on information from an “informant” report, a self report, an AQ-10 which is a brief screening questionnaire and finally a video call. Has the place in Lithuania asked you for any of this type of material before hand?

Hi, I can't speak for Lithuania, as I'm in the UK

No strobes, or annoying smells, I'm afraid!! There was a selection of painless tasks, along with pre-screening questionnaires, and a lengthy interview with an 'informant' (who knew you from a young age).

Just be yourself. Be upfront about exactly why you suspect you meet the criteria for a diagnosis. Tell them what aspects of life that you struggle with 

I too have had a stable and successful career, so don't worry about that. They're seeking repetitive/restrictive behaviours, social difficulties etc

You'll be fine