Children's tests used in adult assessment?

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This really applies to UK (England, specifically) folk only.

I really would like to know who else has experienced their AS assessment including the story book without words (a kid, castles, a dragon etc), and been asked to make up a story as the pages are turned?

Also, the one where a small bag of random objects is emptied onto the table (a Matchbox car, a rubber band, a lolly stick, a coin - that kind of thing) and you're asked to create a scenario and say what it is as you're doing it?

These seemed like tests aimed at children, but the psych tells me they are aimed at adults. She told me I did "too well" in those tests, and my ability at them is causing her to doubt whether she can make a positive diagnosis (this despite everything else pointing that way, as far as I can tell).

Anyone else come across these tests, or tests like them? (actually, though I started off saying this applies in UK only, maybe people from US and elsewhere have encountered this sort of thing, in which case please do chip in!).

I was evaluated in the US a few weeks ago.

I did not do anything like tell a story with matchbox cars, but she did have a children's story book that was pictures only, no words. It was something about flying frogs who went a raided a local town and shocked the residents.

I don't know whether it's typical or not, but it factored heavily in my diagnosis. She said I focused on details and missed the big picture, and that I didn't understand abstract statements about the book, but that I did understand concrete statements about it.

I honestly wonder what I missed. It seemed pretty simple to me, I really have no idea what big picture I was missing.

I was also evaluated in the US a few weeks ago, and was diagnosed two weeks ago and I'm 28.

My assessment did include a story book with no words and the random object story telling. It felt pretty odd and awkward. I'm not sure what the purpose of the items were, other than maybe seeing if I was imaginative? As for the book, my doctor said I noticed and was aware of the people's emotions and reactions in the book (flying frogs everywhere!) and that was good. She didn't say much else about it. I know I only commented on little things in the book and not an overall theme, so maybe I did poorly too, who knows. I'm not sure what the bigger picture would be when it comes to that book though, lol.

I felt I did okay at them. In her final report though they weren't really mentioned, unless I missed it. She kind of focused on every other test more.

That would be the ADOS. It has several modules, one of which (4) is specifically aimed at adults with fluent language. The adult one sounds much as you described.

I've read some research which suggest it does well at diagnosing ASD but a few of the very mildest are not picked up by the specificity and other research which suggests it fails to pick up a significant portion of the mildest ASDers.

Personally, I have mild ASD (descriptive term Aspergers) and the ADOS worked quite well for me - I was suspicious about whether something as easy sounding and childish could work - but it does seem to pick up on underlying skills that I don't have.

My ADOS scores were:

Yes, I had to use props for children too. I wrote about it here in forum last spring actually as I was rather traumatised by the whole assessment.The next day I complained to the department as I felt using children's books and toys just wasn't appropriate and the insult I felt had the potential to interfere with the way I reacted. Having said that, I don't think I would have projected mental states onto more mature objects or pictures. Which is key.

Here's my original thread about it: viewtopic.php?f=3&t=278555

Thanks for the link to your old thread Junior, I've just read the whole thing and found it very interesting (except the side-track about collagen).

You didn't ever say (or did I miss it?) what the outcome of your assessment was. Did you get a positive diagnosis? Was it high functioning autism?

You also didn't reveal the outcome of your complaint (you mentioned the phone call from a senior psychologist, but not the final result). Not important (to me) but it would be interesting to know, if you want to say?

I find the stuff about male/female differences interesting (I'm using that word a lot aren't I? Never mind...). I found something on Youtube recently entitled Adult Female Asperger's Traits. It wasn't a video as such but a series of screens with background pics and lists of 'Traits' over-written. I found almost all of them applied strongly to me. Which made me wonder whether (a) I am untypical for a male, and possess a more female type of mind, or (b) There are actually few differences between male and female AS traits, and the fact that I identify so positively with those on the Youtube video by a female, means very little other than that I have similar AS traits (if all that makes sense!?)

The other thing I found most interesting was re. imagination. I'm pretty sure my psych meant, when she told me I;d done "too well" in those kid's tests, that I had shown too high a level of imagination for somebody with AS. This actually annoys me (if indeed it is what she meant). I just don't see why the fact that I have an ability to imagine things should count against me. I have a very vivid imagination - too vivid for my own good sometimes. That's what a lot of my anxiety stems from, imagining what could happen if this or that were to occur, etc. I can also imagine outcomes / consequences etc. I am 55 years old and I have learned a lot in that time, including ways to imagine what might follow from actions.

I also don't get this business about seeing only details, never the big picture. I can do both. I can focus on the most minute details and analyse until the cows come home (an expression I like), if I'm poring over a legal text, an ecological report or a technical manual for a motorcycle, for example. But if I'm thinking about what's going on in Syria right now, I can't be bothered with the details and I only want to look at the bigger picture of what's happening worldwide, in which what's happening in Syria is just an example.

I've looked at the ADOS link. From what little it gives away, I think I hate it. I hate the idea of being weighed up by some algorithm. I thought the catchphrase went something like: "If you've met one person with Asperger's, you've met one person with Asperger's"?

Well, that's who / what I am, I'm sure. But I get the impression that unless I demonstrate the whole set of classic autism traits, I'm going to be rejected. I'm finding this whole assessment business extremely wearing and very frustrating.

Disclaimer: I am not an expert, I am not trying to diagnose you.

Speaking for myself, my anxiety does not stem from imagining things that might happen. It is often an overreaction to normal interactions. For instance, yesterday my boss assigned me a task for work. Then he said, "Do you want to do that on Monday or Tuesday?" I was instantly flooded with rage, because I didn't want to do it at all! It took me a couple hours to calm down from that, because I had to figure out that even though he said "want", he was not actually implying that I wanted to do the task. It's just a phrasing used to indicate that I have a choice. (By the time I got that far, he had already made the decision for me, which I was grateful for.)

There are many disorders that share a lot of traits in common with autism. I think it is best to focus on what it is that will help make your life better, and not so much on what it is called. If abstract thinking and reciprocal communication are things you are in the typical range for, treatment appropriate for autistic people may not be as useful for you.

Or maybe the clinician blew the diagnosis, that is certainly possible.

Could you give any examples?

Here's some:

http://www.autism.com/related%20disorders

Are there any others? I've just finished looking up all of these (including Angelman Syndrome, which for some reason isn't included int he list) and I can say with certainty that none apply to me! Well, none except for Asperger's syndrome, which is what I thought I was being assessed for. I do get the feeling that the psychologist is looking for more severe traits though. She told me she didn't find anything useful in my school reports because although (as I pointed out to her) they show consistent poor concentration and misbehaviour right through school, they do not report any aggressive behaviour towards other children, or inappropriate use of language, or repetetive or unusual movements etc.

I told her I wouldn't expect a school report to go into that kind of detail anyway, but she seemed to believe they normally would. It is this kind of thing that is making me feel very uneasy about how this assessment is going.

I think the difficulty you may have is that if you currently have good reciprocal communication, you'd need to prove you previously had difficulties with it.This may be why they're focusing on the school reports.

It's true that there are vast differences between people with autism, but it's also true that to be diagnosed with autism you need to meet the criteria. There's a lot of variation in the criteria, but there is still criteria. The DSM 5 does allow for criteria to be met by history but the DSM IV and the ICD 10 do not. In the case that someone wanted to be first diagnosed by history, there'd have to be strong reason for diagnosis and the difficulties would need to meet the criteria which says that it causes difficulties in multiple contexts.

So, in a way the diagnostic criteria is an algorithm. Just having some traits doesn't mean you have autism, having enough traits that cause difficulties does. (From a diagnostic perspective.) It may be that you're on the Broader Autistic Phenotype. It may be that you're one of the minority who don't get picked up by the ADOS but still meet criteria.

My school reports didn't say too much along those lines. but they did say things such as me having difficulty understanding what characters think and I had a note added to my SEN statement (for my hearing) about my literal thinking because it was getting me into trouble. My school reports also said I was quite and polite, however.

I know that my wife, who is a teacher does put those sorts of concerns into school reports when she wants to 'create a paper trail' or there is lacking documentation about difficulties already.

Certainly, your teachers weren't beating around the bush enough not to put that you had poor concentration and misbehaviour. Maybe she thinks that because they wrote those things, they would have written other concerns too. Would they have known those were relevant things to put down? I don't know.

You are entitled to a second opinion, so you may want to look into that. I was diagnosed on my second assessment (Although, I was never actually assessed on my first one... but I was referred for one before my appointments got hijacked by my severe mental health problems. They didn't think I had autism - but when my mental health problems had lessened but my ASD-type difficulties had not I was referred for an assessment and they decided I was an 'obvious' case.)

I think the nature of your imagination is also worth considering. My assessor was of the opinion that people with ASD aren't necessarily unimaginative (though I'm not a particularly imaginative individual) but that its the qualities of the imagination that count. Specifically, social imagination - how good are you at imagining social situations. When you told your story, did you make inferences about the plot/pictures alone, or did you talk about the thoughts and feelings of the character?

Thanks, C.C. for your helpful reply. Last things first:-

I definitely did not make any reference to characters during the tests. I don't think I'm at all good at imagining social situations, but I'd say I'm good at imagining how I want a room or a motorcycle or a boat to look when I've finished working on it (to give a few examples). Or, I can imagine being in certain places, especially landscapes, if I am in the right kind of mood. Social situations, no.

Next, I'm pretty sure that in the early-mid 1970s when I was at school, the teachers wouldn't have thought like your wife. Back then nobody had heard of Asperger's and probably had very limited understanding of autism generally. Which is why I was surprised at my psychologist's surprise.

The AS traits I have do cause me difficulty and always have - that's why I decided to seek a diagnosis. I don't actually expect any 'treatment', or want any. But I do think that having a diagnosis would help quite a lot in itself. I have found that I've felt quite a bit better about myself over the 2 1/2 years since I started looking into Asperger's and realised it was describing me.

I'll have to skip the part about the DSMs and the other code you gave. I know nothing about these. Are they American? Do they apply in England?

Lastly, "reciprocal communication" - does this just mean 'conversation'? Seems as if it must but I'd like to be sure I understand the term.

Thanks again.

I was given the ADOS module 4 about a year and eight months ago, and though I did find some of the tasks rather juvenile (the pantomiming teeth brushing and creating a story with the random objects) the test did actually measure my traits accurately, and pinpointed some difficulties I didn't even realise I had. I scored a 13 overall, and the diagnostic cutoff is 10.

"Reciprocal communication" just means the ability to pass a conversation back and forth; someone says something, and you recognise when to respond, and when to say something to pass the conversation back, as opposed to answering questions without asking any of your own, or monologuing without giving the other person time to speak. That was one of the problems I had that I didn't know I was bad at.

I had the ADOS-2 (module 4) recently. Module 4 is supposed to be for adults. I provided my results for my test in this other topic.

My main qualm with the ADOS is that it focuses a lot on the social aspect and in fact seems to be based very heavily on how weird you seem, while interacting with the examiner, in the examiner's subjective opinion. In fact, I think most of the stupid tasks they have you do are just excuses for interaction.

It could be handy for a good examiner, in conjunction with other things. If you have an IQ of 120+ and a large vocabulary, but your family members tell them about how you can barely hold a job or manage household tasks, that should indicate something.

Normally, I could agree with my examiner's decision that I "have autistic traits" but don't meet the diagnostic criteria, but I was pretty ticked off because he failed acknowledge most of what I told him or any of the non-social stuff. Even when he tried to list my social challenges, he missed the social challenges that I actually have and instead listed stuff that's VERY minor (occasionally misjudging context, adequately treated depression), or non-problem personality traits (introverted, aromantic), or just plain inaccurate (he seemed to think I was previously diagnosed with an anxiety disorder or something). He said I didn't show repetitive behaviors but said I was repetitively figiting with my clothes due to "anxiety." He asked very few questions regarding my current functioning level, and he decided I can handle my finances and daily needs even though I told him I cannot. They did ADI-R and SRS with my mom, and put a lot of stock in what my mom said about my childhood behavior that she didn't witness or have any way of knowing about, even when it was contradictory to what I said.

They required me to bring my roommate with me to the appointment so they could interview him about me with the Vineland Adaptive Behavior Scale (um, not really useful for adults except to determine whether they are intellectually disabled), but then they completely ignored him once he was there, and the examiner literally just didn't understand my attempts to remind him about my roommate. I'm not sure why they thought I brought him. Maybe they thought I needed him along because of my anxiety. The examiner seemed to think I'd want to bring him with me for the "reading the results" appointment even though there would have been no need to that.

His recommendations included "Michelle also may benefit from individual therapy to gain insight into her feelings of depression and anxiety and to learn more adaptive strategies and coping skills to address her underlying emotions. She also may benefit from addressing her anxiety and social awkwardness (per Michelle) in therapy to identify strategies to deal with anxiety and improve her confidence in social situations." In other words, I mainly need to learn to deal with my emotions. Who needs life skills?!

*facepalm* Yeah, I think that list is (mostly) a list of problems that can cause things like intellectual disability, inability to speak, inability to walk, etc. Those could be useful things to consider if you are a parent or clinician trying to interpret a child's behavior, but not for a grown-up who has first-hand knowledge about their own problems.

I'd say the closest Aspergers-like condition acknowledged by the DSM is Social Pragmatic Communication Disorder. If your problems are more in the realm of executive dysfunction, there's Attention Deficit/Hyperactivity Disorder (inattentive or combined type). Among non-DSM problems are Sensory Processing Disorder, Pathological Demand Avoidance, and I think I've seen Executive Function Disorder. (I believe PDA is actually considered to be "on the autism spectrum" in the UK?)

Less similar but maybe still worth a look: non-verbal learning disorder, dyspraxia, reactive attachment disorder, schizoaffective disorder, sluggish cognitive tempo

I've seen people talking about confusing autism with borderline personality disorder and schizophrenia, but I think those are also "another person trying to figure out what your symptoms are based on your behavior" situations.

Okay, I didn't read through the link about autism differential diagnosis because I assumed it would be relevant. I think most of those are, as you've identified, ones related to intellectual disability and the criteria when autism was thought to mostly be severe.

I think Schizoid PD would be more similar than Schizophrenia PD as the latter includes pseudo-hallucinations/delusions. I would think, if you're socially anxious and it's 'more' than social anxiety disorder, then you might also consider Avoidant PD

An article you might be interested in is: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849991/

If you don't have time to read the article, here's the differential diagnoses and the comorbidities:

The article goes through each in more detail and compares them to ASD.

Hiya, in answer to your questions - yes, I received a diagnosis of high functioning autism. (Not that I can fully accept it given how flawed I felt the assessment was). Regards effects of my complaints - the unit said that in the future they would ensure fewer people were present, I think they also said they would be mindful of the lighting situation. Regarding ADOS, they can't change that as the process needs to be uniform across the UK.

Regards male v female minds. Latest discoveries in neuroscience actually strongly suggest that the notion of two distinct male and female brains is a myth. So I guess the differing presentation of males and females in autism (esp on the milder end) is to a significant degree a by-product of cultural conditioning based on daft stereotypes. Fundamentally, beneath the surface of things, the struggles are the same. As for imagination - I agree with what another poster said, it seems to be about social imagination. (I have a great creative imagination). A read into object relations theory helped make a lot more sense of things for me too. Sorry this is fairly short, I'm ill and tired!