Can HFA be missed?

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Hey everyone. My therapist and I have had a hunch I may be High Functioning Autistic for a while now (I know that term is offensive to some and I apologize for that, I only use it to better state what I’m trying to say). I was lucky enough to finally get a full mental evaluation, including a small ASD segment.

My results said that I have BPD, CPTSD, GAD (nothing I didn’t know already, except BPD is now “official”). They said I had a lot of autistic traits, but didn’t meet a full diagnosis. So, I guess my question is… can an autism diagnosis be missed? Can a professional be wrong?

It’s not that I necessarily WANT to be autistic, but I can’t help but relate way too much to it. I know that ASD and my other disorders overlap a lot, but I relate to even to the traits that separate ASD. My therapist also has a lot of experience with autistic people, so I take his word too. Now I have two people telling me different things and I’m very confused and stressed out.

I only saw the specialist for a little while and once compared to the other doctors that I saw for hours and multiple times. I just feel like that, mixed in with high masking, may have caused me to be misdiagnosed. But I could and am open to being wrong.

Looking for other opinions here on how I could move forward. Thank you!

If you can afford it, it definitely does not hurt to get a second opinion. Sometimes professionals have outdated ideas of what autism is, so it is possible for them to miss it.

edit: I don't think many people on this forum will make a fuss over functioning labels, but if you want to avoid them you can say "level 1" instead. The DSM 5 introduced levels in place of functioning labels

Yes, it is possible for people to be misdiagnosed or missed. It is actually quite common and one of the reasons why diagnosis rates are going up.

I saw a specialist; he felt I might be autistic or have a NVLD (not otherwise specified)

Who did the "mental evaluation" ? If you were dx with BPD, CPTSD, GAD, etc. it sounds like it was a psychiatrist because those are mental health conditions. ASD is not a mental health condition. It is most commonly evaluated by a Psychologist or Neuropsychologist who specialises in ASD assessments using standardised tests.

I agree you might want a second opinion if you aren't completely satisfied. At the very least, get a copy of your report showing which tests were administered and how you scored.

@IsabellaLinton

I went to the testing office about 3-4 times and those were mainly for a psychiatric evaluation. However, I did see another doctor during one of those visits that was specifically for ASD assessment. I only saw them for a little while though, so I can’t help but lean more towards the opinion of my therapist who’s known me a lot longer.

Interesting. I'd still want to know what the specialist did to assess you.
Masking shouldn't matter if they're using actual tests, instead of looking at you or asking you questions verbally.
I would assume that person would have some kind of anecdotal record of why they discounted ASD?
I'm not saying they're wrong necessarily but I'm curious how they'd decide so quickly.

It's definitely possible, but probably not as common as under the previous criteria.

The woman doing mine couldn't reach a firm conclusion either way because I already had schizoaffective, ADHD and OCD on my record and even that much was difficult to get a doctor to diagnose as it was generally assumed that ADHD couldn't exist alongside OCD.

Also, just because somebody does fall slightly outside the diagnosable range doesn't necessarily mean that the traits are mild. It can still be enough to make everything more of a hassle than it should be.

Only if you're not that good at masking. Those of us that have made a high art of it can fool just about any test in the short term, just at a substantial cost and if there's other possible diagnoses, it just gets harder.

I was assessed by a psychiatrist. Apparently a psychologist cannot diagnose anything in this country. It is probably different in other countries.

Here the Psychologists have to be PhD with diagnostic training and experience.
Ideally they are Neuropsychologists.

If they don't have these credentials, the assessment report needs to be stamped and filed by a GP or other licensed medical doctor (e.g., psychiatrist), in order to be considered valid.

Conversely, ADHD has to be diagnosed by a Neuropsychiatrist because it involves prescription medication.

How do you mask test answers? I didn't even know what the "right" or "wrong" answer was supposed to be.
A lot of the tests were word games and number games or spatial puzzles.
Maybe that's not the type of testing you received, though.
They don't normally rely on observation or interviewing because otherwise lots of people WOULD fake it.
They need to be accountable to any diagnosis that could involve insurance payments or disability status.

In the U.S. observation actually is a huge part of the assessment process. The assessor is constantly looking at your body language, how you react to socializing with them and anyone else involved, your tone, eye contact, etc. I masked so much that I was refused a diagnosis the second time I was assessed.

Autism can definitely be missed, even during a professional, full assessment. Even moreso with "higher functioning" people and adults, who may mask more or not fit the assessors "idea" of someone with autism. Mine was missed despite two assessments at 6 and 16, and my brother being diagnosed w/ the same symptoms before me.

Hugs Fairfield.

I agree it can be missed even in a decent assessment.
I hope it didn't sound like I thought otherwise.
I know it happened to you and many others here or online in other places.
(Are you going to try again?)

I was just curious about the OP because they said the specialist barely saw them.
Also, their own therapist thinks they're on the spectrum.
I'd want to see the specialist's notes if that happened to me.

This may well vary depending on where you're located, but when I had my exam, there was a lot of observation and the tests that were performed were either something that could be faked or they were tangentially related in terms of things like dyslexia screens which are good for dyslexia, but won't necessarily identify other sequencing problems.

What's more those that are high masking enough to be going through the process as an adult have been at it long enough that the few hours of assessment are within the time limit that we're used to faking normality anyways. I may suck at most human interactions, but that doesn't mean that I'm not a master at certain facial cues, they just aren't they ones I'm supported to be attention to our that help socializing.

As for people faking it, there's little reason to do so as that's just the exam, you'd then be stuck pretending to be autistic forever and hardly anybody bothers jumping through the hoops to get the evaluation of they think they qualify for diagnosis and fake negative. But, it's certainly possible, especially with how closely related schizophrenia, ADHD and OCD are to ASD. Which is probably the route that people would go if for some reason they're being evaluated and don't want an accurate diagnosis.

But at that point, you're probably talking about insurance fraud or a severe personality disorders. And in the former case, you'd just hire a fraudulent doctor and be done with it.