Assessment, ADOS-2 and waiting...

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Yesterday I completed the ADOS-2 Module 4, which was the last thing I had to do as part of my assessment under the diagnostic services with the NHS. I have about 2 weeks to wait until I should receive the report, which I am guessing is the diagnosis / non-diagnosis. The assessment has generally been pretty straight forward. I took my husband with me for support and he corroborated my traits and exaggerated on many things I pointed out, and he told the assessor things about me that I didn't know. It was quite eye-opening in some respects, but also embarrassing in others. At the end of the last assessment, M (the assessor) asked if we had any questions. I didn't, but my husband asked for his opinion; am I on the spectrum or not. I looked at my husband like an absolute idiot, because obviously the assessor wasn't going to say. He did, however, say that I *definitely* have traits, but that the issue is still that I have no one who can validate my childhood development. My mother and her family are people I no longer have contact with, and my Dad wasn't there for a lot of my childhood and also denies my mental health problems. His family are mostly strict Christians who live in a fantasy land where nothing goes wrong, but they pray for the children all over the world, and they have prayed for my strength to recover from my MH problems in the past. Sigh.

During my assessment period, I was able to obtain a couple of letters from a Consultant Child and Adolescent Psychiatrist, who I was under while I was inpatient at a psychiatric unit some 6 years ago.. There was little information, but there was a paragraph in a summary letter which stated: "I met with hra1993's mother for a detailed developmental history. It is clear that hra1993 has a grossly atypical developmental history which is strongly suggestive that she is on the autistic spectrum. Hra1993 has very marked difficulties with social relationships, a lack of empathy and communication problems". It then goes on to say: In addition to these difficulties hra1993 has also experienced significant trauma in her life." In another letter it states: She has a distinct lack of insight into her social and communication difficulties." And then: It seems likely that hra1993 has a previously undiagnosed social and communication disorder, possibly Asperger's Syndrome. In the discharge summary it is stated: "It appears hra1993 has problems with social and communication possibly Asperger's Syndrome."

I also managed to obtain some NHS letters which refer to Asperger's. Last year a letter was written by a Consultant Psychiatrist that reads: "Current Diagnoses: Asperger's Syndrome (ICD-10 code, F84.5)" - However I have never been NHS diagnosed. Later in the letter it says: "In my opinion she has... Asperger's Sydrome..."

I am confused as to why I had to complete the ADOS-2 Module 4. I don't really understand as I felt as thought I was outside the parameters of the assessment. I am a verbally fluent 24 year old female with a husband, 2 children, a mortgage and a job. I am successful in these things. I feel that my husband could have completed the assessment and that we could score the same.

I turned up 45 minutes early for the assessment; I was early as according to my diary the appointment was at 11am and the assessor believed it to be 11:30am. I was in the waiting room at 10:45am. I sat and read my book while I waited but I did feel agitated as time went past 11am.

I was taken into a small room and sat opposite her (there were 4 chairs; 2 chairs each side of a table). The light was on and I didn't ask for it to be switched off. I am not too sensitive to light unless I am looking out or up. She asked what I knew about the test and I said that my original assessor M had said it would seem somewhat patronising. She said it would seem that way, yes. We began.

She laid out a laminated sheet with the outline of a star shape on it. She gave me some pieces and asked me to make the puzzle. She told me it didn't matter how I organised it or what I did with each piece, just to make the puzzle. She said if I need more pieces to ask for more pieces. I completed what I could but ran out of pieces. I didn't pay any attention to colours etc. I said "I need more pieces" and she gave me more. There was 1 yellow and so I discarded that, but that was the only attention I paid to yellow. So I completed the puzzle just fine. I was very anxious and a little shaky but I am not sure she realised that.

Next she showed me a picture book and it the most screwed up picture book I have ever looked at. There was a boy and a Spaniel and they were on a beach and inside the rocks were fossils. On one page the boy appeared to be looking at leaves and there were these sparkly orb looking things and I asked what they were. She asked what I thought they were. I said I didn't know and that whoever wrote this book was obviously high on crystal meth. I turned the page and continued. On one page the Spaniel was a dinosaur in the sky. I said the boy looked confused and she made a note of this - I know it's because I recognised a facial expression. This was the only expression I noticed. On the next page, the dinosaur was a silhouette in the sky and the dog was floating. There were these orb things on the silhouette so I asked: "Oh, are the star things his imagination, is that right?" and she said "Is that what you think" and I said "I guess so". I made what I feel was a story out of an entirely illogical book. I asked her if the book was purpose written and she said she didn't think so. I told her we had just got a puppy and she said she had 2 dogs. She asked what breed my dog was and I told her a beagle and the assessment carried on.

She then told me that I had to show her how to brush my teeth OR make a cup of tea, but we had to do it standing up. I told her I sit down to brush my teeth and so I would make a cup of tea. She said I was stood at the sink and I said "the sink?". Why would I be stood at the sink? I said "well my sink isn't here - it's there in my kitchen" and I nodded my head towards 'there' and I walked to my 'sink'. I verbally told her and acted out how to make a cup of tea, walking across the room etc. I pointed out I don't drink English Breakfast, I drink earl grey, and I told her I needed to tear the teabags as the brand I use come with 2 bags together, with a perforated line to pull apart. I got stuck on putting away the milk and putting the bag in the bin. I did both together and realised I didn't have a free hand so couldn't open my roll-top bin. I told her I felt like a dick.

She asked me if I worked and I told her I had just quit my job. She asked why and I said that I had jokingly told my boss I was going to punch her. My boss is my friend but I got a firm telling off and I had decided that if I wanted to remain friends with my boss then I would have to leave the job. She asked how I met the friend and I said that I met her at a baby group, but also that I had visited the cafe for some 3 years before I started working there, and so I knew her from there too. I said we don't see each other outside of work. She works 6 days a week. She asked what my plans now were, and I said that I start work at another cafe in 2 weeks, and it's dog friendly. She said "so you like dogs?" and I said "yes" and she wrote 'likes dogs' on her paper. Why is that relevant?

She asked me about my husband; how did we meet, what did I find attractive about him, who made the first move? I said it sounds somewhat paedophillic as he's 15 years my senior and I have known him since I was about 13 (online, talking about bikes on a male dominated bike forum). When we first met in person I was 18 and I was on a bike ride and he happened to be there. Everyone knew I was in hospital but on day leave and he was the only person who seemed to accept that I was still me. She asked me what irritated me about him. I said he is a loud eater, he says I can be overbearing and childish and it irritates me that he says he will do things but then doesn't.

She asked where I live and I told her the village name. She asked how I found our property and I asked what she meant? I nearly responded with 'Rightmove'? She asked who picked the house and I said it was my husband as we panic-bought due to me being heavily pregnant. She asked if I would like to move and I said yes, to France, but that's not realistic. I said it makes sense for us to move as we have made money on our property so we could go somewhere larger and have a similar mortgage repayment. She asked something else about our house and I told her the first line of my address. Feel a bit stupid now as am sure that wasn't the correct response she was looking for.

She pulled a fidget spinner and tangle toy out of her bag and put them on the table. After about 10 seconds I took the tangle toy and she said something like "you need one I think; you're rubbing your leg" and I kind of laughed. I hadn't realised I was rubbing my leg, but did feel calmer after playing with the tangle. (I ordered one on Amazon last night). She took out another tangle and I said I preferred the colours and she handed it to me and I took it and put the other one down.

She asked me about emotions. How do I know I am happy? I said I don't know. The opposite of sad. I am smiley. She asked what makes me happy and I said "when my boys are happy". She asked me how anxious feels and I said "I don't know what to do with myself and teary, I guess". She asked me how angry feels and I said "I don't know. Tense and loud inside I guess". She asked me how sad feels and I said "teary, and I don't want to do anything".

She asked me quite a few things about quite a lot of things. I replied to all questions and offered spontaneous information also.

She asked what I liked doing in my spare time and I said I liked writing penpal letters, that I love cooking, and I like documentaries. She asked what documentaries and I told her true crime. She asked which case in my favourite and I said I love the Denis Neilsen case. I said he's not Fred West evil; he had an immense fear of abandonment after the death of his Grandad. I said I couldn't have a bath knowing there was a dead body in the ottoman next to me. I also got quite excited when I remembered I had a penpal letter to send in my bag and so I pulled it out and showed her.

She asked me if I get lonely and I said "yes, all the time". She said "do you have any friends you could tell me about?" and I said "No". I said I used to have a friend and we stayed with her during our house renovation for 2 weeks but her husband had pretty much said that our youngest son crying was irritating and that I spent 2 weeks wandering around outside with the pushchair as not to be in their way. I said that I usually babysit her child on a Tuesday as my son loves her and when friend collects her child she would spend an hour having a cup of tea, but not anymore. I said my husband says I am being taken advantage of and I should stop. I also told her about a friend I used to have (who was a manager at my first job 6 years ago); a male more than double my age, balding, and not my type. His wife accused me of having an affair with him on Christmas Eve last year. I said how we met every couple of months for just a coffee, and I took my son with me, so we weren't have a secret rendezvous at a hotel. She said "so there was nothing more?" (or something to that effect) and I scoffed and said no.

She then pulled out a bag of random children's toys and picked out 5 objects and made a story. Her story didn't really make much sense to be honest and I felt it was a bit stupid. I got completely stuck on this. I picked out a toy car, a bag clip, a paper clip, a plastic hippo and a flower with leaves. I sat staring at the objects for about 5 minutes and was, I feel, visibly quite agitated. I started crying and she asked if I wanted to pass and I said yes. She got a tissue and held it out and I took it.

That was the end of the assessment. She told me a little more about the ADOS-2 overall but the information was limited. She said I would likely know in around 2 weeks. She said she hadn't read my files as she didn't want a preconception of my personality / traits / skills etc. That makes sense I guess.

What the hell was the ADOS-2 all about? It seemed absolutely ridiculous. I can't remember some of it.

She did explain that it didn't allow for diagnosis but was part of the overall assessment. I know other females my age who have been assessed recently and diagnosed without doing the ADOS-2, by the same services in my city, so I don't understand why I needed to do it.

I am going to spend the next 2 weeks in a state of anxiety to the most immeasurable levels. If the report says I don't meet criteria then I wonder if that'll set me on the brink of another nervous breakdown.

Hmpf.

Thank for listening... I really needed to type that out and get it off my chest.

I have also remembered she presented me a Where's Wally style picture of a beach with people on it. She said it was to provoke or remind me of any holidays I had been on. I said it reminded me of Spain. She asked where in Spain and I said I didn't know. I said I didn't like it very much and she asked why. I said I just didn't. My mum drank a lot at the bar. She said something along the lines of "so you were with your family? You mentioned earlier that you didn't get along with her". Or something to that effect. I don't actually remember talking about Mum prior to that, but she was right as I don't get along with her and now have 0 contact. I think I said I preferred France, and now I know I made several references to France throughout the assessment.

She also said she wanted to talk about dreams and the future. I had previously mentioned I am about to start an Honours degree in Forensic Psychology. I said to be honest, I never see myself returning to full time work and that eventually we will move to France as once my in-laws die there is nothing for me in England, so that's a feasible idea. She said "well if you become a Forensic Psychologist you'll have to talk to people eventually" and I said something along the lines of "there are lots of things I could do with that degree. I don't have to be a Forensic Psychologist. If I did want to be then I'd need to do a Masters and a Doctorate too". She asked "what else could you do with the degree?" and I said "well I don't know. Lots of stuff". I think that was the end of that conversation.

Damn I am confused.

You are over thinking this test. It will seem like the test is meant for children because of its simplicity but it is also applicable to adults. Most of what you say during the test is irrelevant and ignored and there are no correct answers. They are really only interested in your behaviors, in how you respond, not the content of your answers with the exception of noting any restricted interests or your level of creativity and imagination. They will note your eye contact and ability to have back and forth conversation. They might try to create an emotional response in you by joking or trying to make you angry to see how you react. The test is nothing how it may appear and since people do not know how the test is actually being scored there is little anyone can do to fake pass or fail.