Skype Diagnosis With Tania Marshall

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Hi Everyone -- I'm posting on my recent experience with an evaluation on Skye with Tania Marshall.

I'm a woman in my late 30s with a healthy dislike for therapists. They tend to say I'm "emotionally unavailable" and that I am expressing myself "well"...even when I'm complaining that I have difficulty articulating what I mean. They tend to gaslight me (https://seventhvoice.wordpress.com/2014/12/10/the-gas-lighting-of-women-and-girls-on-the-autism-spectrum/). It's not pleasant.

I've read EVERYTHING I can find on people like me: twice-exceptional, gifted, adult women with ASD. That last one is tricky, but I have taught myself everything I can from online sources, books, and PubMed. I knew I likely had ASD but I was dreading paying several thousand dollars to have a team of therapists attempt to misunderstand me.

I wasn't sure about Tania Marshall's online service. A therapist I was seeing (who could not diagnose ASD but who suspected it) advised against seeking this kind of evaluation. He caused me a lot of harm, so I decided to ignore him on this.

What sold me on Tanya was not the low cost (a tenth of what I would pay in the US system): it was that she has experience with adult women on the spectrum. My mother was evaluated at Duke Hospital as part of a study (she is not on the spectrum) and received the usual battery of tests...many of which were designed for children. Simply put, I had no faith in the current US diagnostic system or its tools as they pertain to adult women. You are welcome to disagree with me there, but that's my stance.

Tania evaluated me based on:

-- two four-hour discussions with me on Skype.
-- a five-page account I wrote of my life and why I think I am on the spectrum
-- emails from my mother and husband on my strengths and challenges
-- my RAADS-R results (self-administered)
-- my artwork, such as it is (to evaluate "talents")

She said she looks for the DSM-V criteria and also for "themes" she has commonly seen among women with ASD. She did not list them all for me, but did say that feeling rejected socially, being shy and withdrawn, thinking too much, and having a strong sense of justice -- all from an early age and throughout her lifetime -- are the common themes among ASD women and which she saw in me. Also, sensory issues. This is where the artwork comes in, too: people on the spectrum tend to have "talents," usually in art, science, or math. I focused on learning languages, so my artwork was pretty crappy.

Unlike other therapists, I found she tended to accept what I said at face value without having a hidden agenda. I am used to feeling "managed" by therapists -- manipulated really -- and I didn't get this sense at all. I was able to say and react naturally without her misunderstanding me. This is exactly why I wanted to be evaluated by someone familiar with women on the spectrum: I did not want to have to explain my body language or reactions. I didn't have to, and that was nice. I was able to relax and let down my guard.

One negative is that she wasn't able to evaluate eye contact or my stimming. About a half hour into the conversations, my muscles in my legs and arms began contracting and I began moving my hands. I knew she couldn't see this, so I told her about it. Again, some people may want the evaluator to be able to see body language more clearly. I was fine with this method. I told her that I had studied eye contact, so we didn't think it was important to evaluate.

One bias I've heard (and had myself) is that these kinds of evaluations can be slanted toward accepting all comers as being on the spectrum: diagnosis mills or some such. My mind was put at ease when Tania told me that she sees clients who are not on the spectrum, but who have similar challenges because they are gifted or twice exceptional, or who have ADHD. She said that not everyone who comes to her for evaluation has ASD, although many are on the neurodiverse spectrum.

She did evaluate me as having ASD in the end. Please let me know if you have any questions or otherwise want to talk about the process.

I told her I would be writing about this on WrongPlanet, and she asked me to forward this information along:

A link on her website that directs people to professionals in a variety of countries who work with females and/or are knowledgeable about females on the Spectrum:
http://taniamarshall.com/female-asc-professionals.html

And a page on the female gender bias, discussing why women with ASD are often missed or misdiagnosed:
http://sfari.org/sfari-community/community-blog/webinar-series/2015/webinar-the-female-autism-conundrum

Thanks for sharing your experience

Could I ask how much it cost in USD?

One questionnaire and no formal cognitive tests whatsoever? Seems shady. Did she take a thorough case history?

Does this person have a regular psychology practice? I couldn't figure that out by looking through her website.

It was just under $400. I think there was a discount going on, too.

Starkid: Yes, as I mentioned, she sees people regularly for other issues than ASD. She has a regular practice.

As I mentioned, she took a thorough case history. It was a four-hour discussion and involved me, my husband, and my mother. This part was more extensive than what my mother received at her Duke University assessment.

Also, as I mentioned, she used the RAADS-R, which I'm also not a fan of, but it's mostly OK. I forgot to mention that she also uses the Reading the Mind in the Eyes test.

The formal cognitive tests available are not designed for adult women on the spectrum. Personally, I think it's shady to use tools designed for children to evaluate adults. Her website says she does use those formal tools for children, though.

Tania also asked me to pass this along in an email to me:

Dryope, just wanted to thank you for telling about your experience of getting diagnosed by Tania Marshall. Reading your account prompted me to contact her and I'm really glad that I did.

For others wondering, Tania's workup was based on the following testing and other information...

* 9 pages of essays and explanation from myself, along with several additional pages of followup
* a list of my strengths and challenges written by my wife and son
* Testing - Autism quotient and the RAADS-R
* A total of 6.5 hours of videochat interviews (we ended up using google hangouts as skype was more flakey connection-wise).
* I sent her links to some of websites, the books I've written, etc.

I won't get the full written report for a few weeks (they are about to go into their summer vacation in Australia) but she has given me a preliminary diagnosis of autism spectrum disorder (FYI, she like me is not keen on the DSM-V and prefers to the term aspergers as a better description of me, but does use the DSMV definitions for her report).

Overall, this ranks as being one of two best interactions I've had with a mental health care professional in my life (I've met with quite a few of them). She has a long-waiting list for regular on-going sessions or else I would be working with her on a weekly basis. I especially appreciated the last hour or so of the session when we discussed next steps, and how this knowledge could be a positive empowering thing, as well as how I can make some traction in some of the parts of my life that I'm dissatisfied with right now.

I'm so glad this worked out for you. I think this is a good route for adults looking for clarity.

Talking to her is a bizarre experience after talking to the usual therapists. I was treated as a human being, not a person needing passive-aggressive correction. She's a mensch.

Also for those wondering, the cost was $650 Australian, which came out to around $450 or so in US dollars. Much, much cheaper than comparable services here in the US.

Thank you OP, that was extremely interesting and refreshing to read about.

I can't find any of her books in any libraries and don't have the money to buy, right now. Any idea why the libraries would not carry a book on the best seller list?

My thoughts here are conflicted.

On the one hand:

- I understand how it feels to wonder if you are autistic. I was diagnosed (eventually) as a teenager. A professional opinion is extremely valuable.
- you got more interaction than I did in my "formal" diagnoses
- I work with a non clinical psychologist and she has been fantastic. She also provided me with a written opinion on request to aid me getting services (they wanted something 'more recent'). (She'd been working with me over a year)

On the other:

- she's not a Dr, she only has a masters.
- as far as I can tell she has no clinical oversight.
- why so cheap? Feels too cheap, that makes me wonder why she is spending time doing this and not other more profitable avenues.

I'm speaking with Sarah in a few weeks time (we're both at an event!) so I will ask her opinion as she is someone I trust.

If it brings you closure, then that's important and worthwhile. For the rest, I am skeptical but happy to see evidence of her standing and clinical oversight. If she has that then awesome, a nice affordable route is very useful.

J&L

This thread was most interesting to me because my diagnosis was offered by a doctor who also offered Skype evaluations. I hadn't heard any other doctors do that before, so now this Tania Marshall is the second such doctor I've heard of who offers such services.

My evaluations and eventual diagnosis did not involve Skype, they occurred through in-person visits to a local psychologist (with a Ph.D.) who specializes in autism spectrum disorders. I was taken through one lengthy interview in person, through which the doctor completed three separate assessments. In addition, I completed 6 separate written assessments, and my wife completed one for which a family member needed to fill out. In my case, 10 different evaluations were performed, and led to my ASD Level 1 diagnosis. He actually mentioned wrongplanet.net as a resource following my diagnosis, too (but I already was a member here by that time ).

I live in the United States. Since I live only 5 miles from his office, I was able to do everything in person, but this doctor offered evaluations via Skype for those who were not in the Denver, Colorado vicinity. This doctor runs a small private practice, and is only licensed for the states of Colorado and Texas. If residents of either CO or TX would like more information, please PM me and I can give you his contact information.

This is part of my point tania is a not a doctor or regulated by a medical council. She's a member of an association but as far as I can see has no legal and regulatory body.

Sounds like the Dr you mention is still the only Doctor doing it.

What tania offer is really interesting but is not the same as a diagnoses made by actual medical doctor etc.

The value of what she offers is clear but I think it's important to be clear of what she isn't offering (and on her site she is. She never claims to be a medical Dr etc, she's doing it right.)

Spacedoutandsmiling,

Great questions and thoughts. Here are a few responses that may or may not be helpful...

1. On the issue of her degree - In Australia, the most-common terminal degree for psychology is a Masters degree. See -https://en.wikipedia.org/wiki/Psychologist#Australia This is also case in many other parts of the world.
2. The issue of low cost- I think there are two reasons for this. First, she seems to be pretty fired up about the issue of inappropriate/underdiagnosis of women and adults generally and doesn't want cost to be a barrier for help, but secondly many of her patients who see her for a diagnosis end up later hiring her for ongoing care. Personally I'm not sure this is a good business model for her --- as someone who is transitioning out of work as an attorney after serious burnout, I think there is a real danger in a professional overworking his/herself and not charging high enough fees, but that doesn't affect my opinion of the quality of her work.
3. On the issue of clinical oversight --- I'm afraid I'm not as well-versed on this issue as I should be so I can't respond to that issue.

Spacedoutandsmiling,

I checked with the Australia licensing authorities and she is licensed (and governed by the Australia practice rules) as a psychologist in Australia.

Here's the listing for her from the Australia Health Practictioner Regulation Agency:

http://www.ahpra.gov.au/Registration/Registers-of-Practitioners.aspx?q=PSY0000982367&t=GpuCoYGoDxhAhc9dvF4Y