Autism Evaluation Process

April is National Autism Awareness Month, so I wanted to post about topics that relate to the autism aspects of my professional training and practice. One piece that is often not discussed is what actually goes into an autism diagnostic evaluation - for patient and practitioner alike.

I take the process of conducting an autism diagnostic evaluation very seriously. I try to give as much of myself as I can intellectually and emotionally in order to provide patients and families with guidance. My goal is to offer an evaluation that is compassionate, informative, and useful.

These are the measures I routinely use as part of an autism diagnostic evaluation:

• Autism Diagnostic Observation Schedule - Second Edition (ADOS-2) - clinician-administered
• Social Communication Questionnaire (SCQ) - caregiver report
• Social Responsiveness Scale - Second Edition (SRS-2) - caregiver & self-report
• Detailed Developmental History - caregiver report
• Chart Review - pediatric medical records and educational services & assessment history

As outlined above, the diagnostic evaluation is not just me and the patient taking a prescribed set of tests. It is often what I learn in the life narrative that gives me the confidence to proceed with a clear diagnosis and treatment plan. In order to get this information and an accurate health history, I need to talk to caregivers and review pediatric records. This is true for my adult patients seeking a diagnosis as well. While it may seem like a long time ago, childhood behaviors as reported by caregivers give me a fuller picture of the patient's life. 

Beyond the ADOS, I provide anxiety, ADHD, and mood screening Instruments when applicable. An evaluation is so much more than a "Yes" or "No" stamp for a single diagnosis, as it represents a person and a plan to improve their lives based on the challenges they have had and face today.

The inspiration for my wanting to be Ever Better at conducting autism diagnostic evaluations comes from the families I've met along the way. Those who've talked with me about what went well and what they wished could've been different on the day they learned the diagnosis.

I've also found new inspiration and room for growth in working with adults who are seeking a diagnosis later in life. The feelings and dynamics of obtaining a first diagnosis as an adult are something I am learning to navigate with my clients, and I am honored to learn with them.

I am starting to get into a rhythm with scheduling diagnostic evaluations, and I hope to keep receiving referrals for individuals across the lifespan who wonder if they're on the spectrum. In private practice, I am afforded more flexibility in scheduling and administering tests. What this has meant is that patients can get an appointment more quickly and often during "outside of typical office hours" so they can get the answers and help they are seeking more smoothly. 

This April, I'm providing autism diagnostic evaluations on Saturday mornings. So far, I have enjoyed serving new patients in a timely manner - it is very fulfilling for me to get a call from a new referral and be able to serve them within a week or two of their inquiry. Providing answers and helping families better understand their loved ones is one of the most satisfying parts of my work, and I am grateful for the opportunity to serve patients and families in this way.

Faith in Data

I was first introduced to Dan Habib's work at a film viewing of Including Samuel that he hosted at the Dryden Theater at the George Eastman Museum here in Rochester about 7 years ago. I've followed him ever since, and I recently watched this video about inclusive education which rings true to the ideals many families hold dearly. One comment in the video really struck home because it reminded me of how data helps us know how and when to push and adapt our practices.

“I’m going to push you until you give me what’s inside of you”

— 7:48 minutes into the video

That’s what I’m talking about! And I buy what’s she saying hook, line, and sinker because it’s backed by the collection and recurrent use of data. I’ve been sitting on this idea for a while, and this video has inspired me to write it up. By way of analogy, this quote made me think about my favorite verse in the entire bible: 

“Even so faith, if it has no works, is dead, being by itself.”

— James 2:17

I remember very vividly my sophomore religion teacher, William Jauquet, dropping bible verses on us, and he tersely summarized this verse as “faith without works is dead.” I believe this line wholeheartedly, and I try to apply it to my work as a psychologist as such: “Even so therapy, if it has no data, is non-falsifiable, being by itself.”

So what am I trying to get at here?

I want to provide care that is informed by data and to measure clinical change. This is why I am giving clients and their families forms to complete on a routine basis to help gauge their progress and to better adapt our work together.

Since my practice just started (3 weeks in, hooray!) I am seeing a lot of new clients for the very first time. These intake appointments have been a great opportunity for me to collect data from clients and their families using standardized measures, and to integrate this data into my practice as an index of clinical change. I am working to screen for a range of clinical concerns and to have on-going, data-driven discussions about client's unique symptoms and to measure their personal progress. I hope this data-informed approach will be useful to my clients, and also provide me with real-time feedback so I can better meet their needs.

This is what I would love to hear more about from folks who read this blog:

• What measures do you use as part of your work? Recommend them to me.
• What domains/aspects do you think are important to measure? How do we do this?
• How often is too often/too little/just right for measuring change in your opinion?

I’m wearing my clinical scientist hat here and would love to hear more from you!

First Week Follow Up

I had an amazing first week in private practice. I met with 13 different families at both of my office locations and learned about their children who ranged in age from 4- to 22-years-old. The diversity of strengths and interests of each child, adolescent, and young adult gives me a great deal of hope and excitement about the weeks ahead as we forge a therapeutic relationship. Their families are incredibly engaged and motivated to help their loved ones flourish.

I am excited, too, that I have another 10 new clients scheduled for next week and a few additional new clients scheduled for my third week of practice. I really can’t thank my colleagues and friends enough for “getting the word out” about my practice and helping to build my schedule with wonderful new people. Rest assured, there is still plenty of space left, and I am eager to welcome more new clients in the coming weeks.

I’ve had folks from a few different organizations reach out to me asking if I have a flyer to share with them that they can hand out to families. I did not have a flyer, and I think it is a fabulous idea. I developed a first edition flyer to view, share, and download here. 

Please feel free to share it with others who may be interested. You can offer feedback on the flyer by reaching out to me directly, or in the comments section of this blog post. 

Thank you!

I hear you! Website updates

First, I want to give a big THANK YOU to everyone who has supported me by visiting my website! Building the website was definitely a labor of love that my wife gratefully led. She was happy to be able to use all of those pictures on our phones where we tried to capture that perfect moment… only to get the back of our kids' heads instead.

I really appreciate feedback I've received about the website. Friends, co-workers, and clients have helped me fix typos, broken links, and other issues to make the website better. They have also provided invaluable insight for how to improve the clarity and usability of the website.

Two recent additions are the direct result of this honest feedback:

1. The addition of the Clients tab. 

2. The ability to subscribe to this blog.

I have experience and competency working with people at different ages. However, I learned from folks who visited the website that it seemed to focus more on children and adolescents – maybe it was all of those back of my kids’ head photos. To address this, I added a Clients page to outline my training and competencies with children and adolescents, adults, and caregivers.

The blog subscription was a complex challenge my better half tackled head-on.  After reading forums and testing products, she added the subscribe button – which you see as the gray triangle at the bottom right of your screen. If you don’t want to miss a post, simply enter your email address and you will receive each new post in your inbox. I promise to not use this list for any means other than sending out the newest blog posts.

Thank you again for your feedback and support. It was a huge decision to enter into private practice after 9 years (!!!) at the University of Rochester, and I am eagerly awaiting July 11 when I will see my first patients in my new office. I've been really looking forward to this day.

I will leave you today with another aforementioned back-of-the-head-kid-photography gem for your viewing pleasure.