Evaluation Rant

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Hi everybody, I've been a long time lurker of this site and maybe I shouldn't even bother posting this here, but I really don't have anywhere else to vent to or have some emotional support. I've had some long time issues and many many misdiagnoses. I came across aspergers months ago at this point and couldn't believe how much it had described me. There weren't any autism specialists in my area for adults, but there was an ADHD specialist who did psychoeducational assessments. I dropped out of HS and got my GED after years of struggling to cope with school, so I figured maybe that would be the best way to go. I'd go in without any mention of suspecting I was on the spectrum since I thought she'd catch it since she's qualified to diagnose it if I were while simultaneously identifying weak points to create a plan before going onto college.

I guess I'll just jump right in and summarize how the result portion went today. I went in without either of my parents as I'm nearly 18 and feel I'm old enough to deal with these matters on my own and things, well, went pretty terribly. She went over the results with me and said that I'd be receiving a written report in a week or two. The psychoeducational assessment consisted of an IQ test, some self-reporting executive functioning (which I feel I definitely struggle with) forms, and other education related tests. Some highlighted results I was told...
"You have a lot of strengths, but also have some rather significant areas of weaknesses."
- My written expression is superior to my oral.
- Working memory was good.
- Reading comprehension was excellent when it came to silently read excerpts and multiple choice questions, but fell a bit short when it came to things read aloud and open-ended questions.
- Issues with processing information, which was markedly shown when it came to timed tests. She said that this was probably a reason that I had great issue with high school and that it shouldn't be as detrimental in college because of the way it is set up. Said this was most apparent when I was given symbols for different words and had to go through the lines of symbols saying the words that they represent to create sentences along with "Name however many animals you can come up with in a minute", "Name however many foods you can come up with in a minute", and "Say however many names you can come up with in a minute".
- I was actually diagnosed ADHD in childhood and she said that while I do not display any impulsivity or hyperactivity, I still have difficulties with attention.
- Said I had no learning disorders.
- Didn't diagnose me with anything or mention anything specific that she thought would be possible.

After she said all of this, she started to get into reviews of executive function and emotional aspects. I did not react well to put it simply. She said that my anxiety and fear is a big deterring factor, which I definitely agree with. She said that I do not cope or respond typically emotionally when it comes to things that I find mentally or physically overwhelming. This is true, but I also firmly believe the "physically overwhelming" is a sensory issue as there is no anticipatory anxiety nor a quickened heart rate in these situations. I tried to explain this to her a few sessions prior, but I believe my attempt at distinguishing it from anxiety was futile as I just wasn't able to articulate it well enough. Plus, isn't emotional regulation an aspect of exec functioning??? This wasn't what really set me off, though, as I do agree that I have severe anxiety along with emotional regulation issues (always in response to situations, sometimes over reactive, but still never feeling things "just because"). After this, she said that while I expressed that I believe that I have executive functioning difficulties, the self-reporting forms I filled out did not indicate that I do and she believes that any executive functioning problems I have can be attributed to anxiety.

I felt misunderstood, shattered, and entirely invalidated by this. I have problems with daily living things like hygiene, housework, and organization every single day. I do not experience anxiety when I'm hanging out around my house, so I fail to see how it supposedly explains it. These were forms filled out by myself, though, so couldn't the reason that I'd appear to not have any exec functioning problems be because I failed to self-report accurately? I'm not good at those kinds of things. After this, I withdrew and starting crying because I became too overwhelmed by it. I just went off somewhere else and stopped being able to respond to her. She said she recommended I see a therapist as well as seeing her for sorting out college stuff (which I honestly wouldn't have been upset by if it weren't for the invalidation of what I believe to be exec functioning problems). She said that she didn't feel comfortable with me driving home by myself at that point and called around to find somebody to come. My mother came and she quickly reviewed the results and said "She seems to have calmed down at this point, but I was honestly too worried to allow her to leave by herself as she had completely shutdown and disconnected." I spent a good 30 minutes of the appointment rocking, the kind of crying when tears silently stream but nothing else, and tracing patterns in things around the room, so I guess I did shutdown, but this just resulted in me being ticked off because I would have been OK had I just gone out to my car, calmed down, and driven home.

So I guess this confirms that I'm not on the spectrum? I obviously didn't have an assessment done for an ASD, but I would think an expert in a related field would be able to spot or suspect it if I were? I'm just frustrated. I feel like I didn't explain things well enough and when I tried that I failed to do so accurately. Maybe I should have mentioned that I was wondering if being somewhere on the spectrum was a possibility so at least I'd have a straight answer and not be left here feeling lost. I'm very curious to see the written report so I can dissect some things myself, so I will be anxiously awaiting that. I just wish I could have written all of my responses to her, because I think it would have been far more accurate or that I could be observed in daily life or something like that and wouldn't have to explain anything.

I just want to clarify that I didn't go in mentioning that I suspected anything as I didn't want possible confirmation bias get in the way.

Last edited by LurkerAm on 05 Nov 2014, 6:16 pm, edited 1 time in total.

It sounds like the therapist assessed you pretty thoroughly but I don't know that I would 100% rule out being on the Spectrum at this point. It really is best to find someone who is qualified to assess ASD in adult females in order to completely rule that out. You mentioned in your area it is difficult to find a qualified person. Perhaps if you go away for college or when you get older and you can go on your own to another area you can be evaluated again. I am not saying that you should keep getting tested until you find someone to tell you what you want to hear, I just think that it is better if you can be tested by someone who specializes in ASDs in adult females so that you can be 100% sure.

And welcome to WP. I hope this will be a source of encouragement and support for you.

No. It means simply that your diagnostician didn't find the information that she expected to find. My own diagnostic story matches yours in many ways, it is scary. My diagnostician declined to diagnose my Asperger's Syndrome (AS) despite diagnosing two AS factors (GAD and OCD) in addition to my juvenile diagnosis of depression. She ignored my many recognized lifelong characteristics which match those of individuals who are known to have AS or other autism-spectrum disorders (ASDs) and my University of Cambridge Autism Research Centre screening-test scores for the AQ test and its core factor tests. Worse, my diagnostician had me complete a multiphasic personality test which has never been accepted as a diagnostic tool for AS or other ASDs. Basing her decision only on my multiphasic test scores, she "found little evidence to confirm AS." Well, sh'yeah! She ignored (and didn't even discuss) all the evidence I had brought to the table. She actually said "congratulations, you probably cured yourself."

Since then, I have come to realize that a diagnosis wouldn't help me legally, medically, professionally or socially. My evidence informs me about my AS more than anything my failed diagnosis does. I am happy with saying that I am "screened with AS." In many ways, a diagnosis might risk certain parts of my life.

But, enough about my story.

Where do you want to go from here? You can try for another diagnosis from a different diagnostician. You can complete the AQ and core factor tests. You can simply "know" yourself and accept what you have always believed about yourself. If you are almost 18 years of age, you would be seeking a diagnosis of adult AS. Such a diagnosis in the United States is very difficult because there is no single, standardized, accepted diagnostic tool or test for adult AS. That fact might hamper your expect diagnosis. Of course, there are universities and other diagnostic facilities who will happily diagnose you for about $1,500. For me, at least, that price was our of reach for something that, at this point in my life, wouldn't have yielded anything more than personal satisfication.

In any case, good luck with whatever you choose to do. I remember the same feeling of being "misunderstood, shattered, and entirely invalidated." The ugly truth is that a LOT of diagnosticians are in over their heads, don't know how to diagnose adults, and try their best to fill in the data with mistaken tests. Meanwhile, stick around Wrong Planet. A lot of us have experienced the same things and found ways around the problems of a good diagnosis.

Last edited by AspieUtah on 05 Nov 2014, 12:44 pm, edited 1 time in total.

When I was assessed, the follow up visit did not include giving me a verbal diagnosis, that came with the full report that was mailed to me about a week later. So, while I understand your being upset, wait to see the full written assessment results.

I also left the follow up visit with the neuropsych feeling like she didn't confirm or rule out any diagnosis, though I felt anxious from that, she did tell me that the written report would contain detailed diagnosis and treatment strategies.

Thanks for the responses, guys. I've calmed down a bit since my original post, granted I'm also emotionally drained at this point. By the end of it all, I was mainly just upset that I ended up feeling the same way I did with every other mental health professional I've ever spoken to. She started telling my mother how she thought I was feeling when she got there and that is something that has always really upset me as my outward expression doesn't tend to accurately match up with my real feelings or they may seem exaggerated compared to the degree I'm actually feeling.

I'm not sure if I'll end up seeking an ASD specific assessment in the future, but I guess if I really feel like this is something that I need closure on either way for peace of mind then it's definitely a possibility. This one did just cost 2k, so if I do then it will be awhile. The woman said that she thinks I'm eligible and deserving of supports for college/university, which was one of the biggest reasons I even got this done. My only thing there is I know that you have to have a diagnosis for that kind of stuff, so I find it unsettling that I don't know what it will be. I'm betting on just an anxiety disorder, I guess. On the subject of my anxiety, I feel like whenever my anxiety is brought into question with mental health professionals, everything is solely because of *just* anxiety and swept under the blanket when I raise concerns.

Last edited by LurkerAm on 05 Nov 2014, 4:58 pm, edited 1 time in total.

You said this woman specialised in ADHD; was there anything in her academic profile about her knowing anything about ASDs? ADHD and ASD are similar in some ways, but by and large they are strikingly different disorders. Perhaps, given her area of expertise, your diagnostician was looking for signs of ADHD and never thought to consider autism? You might talk to her about that when you get the written report. I wouldn't write this off as your not being on the spectrum, merely as a miscommunication about expectations.

Yes, she was definitely looking for signs of ADHD mostly, but she also asked questions that would seem to be ASD related like routines and such at the consultation. Her profile says that she does have experience with AS. Her specialties list learning disorders, ADHD, testing and evaluation, but AS is on her "other" list as well. She sees all ages, so whether or not the AS experience is almost exclusively with children is unknown to me. Like I said, I was going into this for gain further than just a possible ASD diagnosis, so I think I've still gained something at least.

Maybe you should call her and ask her if she officially diagnosed you with anything instead of waiting for the written report.
What were some of the questions on the EF self-report?
It seems like you would test positive for EF problems if you have problems with daily life tasks.

I do not remember what the questions were specifically as that was 2+ weeks ago at this point, but I searched around for what the test I took scored for.

Inhibit (impulsiveness)
Shift (flexibility)
Emotional Control
Self-Monitor
Initiate
Working Memory
Plan/Organize
Task Monitor
Organization of Materials

This test was definitely geared towards ADHD. Based on what she was telling me, I believe I probably scored poorly on flexibility, initiation, and emotional control. She went on to explain that any problems I experience seem to be the result of self-esteem and fear, which can also result in rigidity and failure to initiate timely. While I don't disagree that it can play a factor in specific situations (school and high stress locations/situations) for me, there is no reason I should be struggling this much to initiate tasks around the house and carry them out to completion, etc. There was no "I think you should seek further help with a therapist and then we'll see if the executive functioning problems continue", just that she straight up doesn't think I have them based my self-report.

I think the big thing is that mental health professionals only see me in their office, an environment and situation I tend to find highly stressful, and I constantly seem like I'm on my last hinge in their presence. Then on top of this, they are only described my anxiety by myself and my parents in situations that are a bit extreme in relation to my everyday life now (school and such). They then think that I try to minimize the anxiety I experience in my daily life and my personal opinions on situations become overridden by their professional opinion.

I've walked away feeling misunderstood and great resentment towards every professional I've seen in the mental health field. I do understand that they are professionals and have quite a bit of experience, but I think some of them get too stuck in their own assumptions because of that and do not fully take in what their clients say. I'm sorry that you're feeling frustrated and upset by all of this. I would wait out for the written report and hopefully you can gain some clarity on the situation again and go from there. I would not entirely rule out you being on the spectrum especially since you said that even the woman you saw claimed that you shutdown.

I am pretty sure I took this test. It is geared towered finding Executive Function Deficits common to both ADHD and the Autism Spectrum. The single most important thing people who are not specialists in Adult, and Adult Females miss is we "cope", "mask" or "act" to the point we seen normal. Doing this is exhausting and mentally harmful in the long run. It is shattering when it is not even considered by professionals who just don't know to even know to look for masking. In fairness to her it was not a ASD assessment and you were not dismissed out of hand or told you are just a drama queen or have fictitious disorder as many here have experienced. Even though it may be only partly what you need you will be recommended for supports. If professional can't diagnose you neither can I. Stick around here read the posts. Either you will have a lot of OMG that's me I did not know there are other people that do this or you won't.