ASD Evaluations in Adolescents and Adults: Differences, Challenges, and Benefits

How people arrive at my door.

Individuals of different ages suspected of having an Autism Spectrum Disorder (ASD) make their way to my office for a variety of reasons. Maybe they are struggling at school or in their place of employment. Perhaps a family member or a teacher has observed something “concerning” or “off.” Some are concerned they may lose their job, or that their marriage is suffering, or are unsure how to connect with their kids. Often individuals are in my office because they are just struggling, not having success in life, not able to achieve their goals, and they don’t understand why.

What is different about assessing adolescents and adults versus younger children?

Often times, younger children are not able to answer questions about their thoughts and feelings and they may not yet have insight into their own challenges. For those reasons, evaluations are based largely on caregiver report, observations, and clinical interpretation of behaviors. Adolescents and adults can often answer questions directly about their thoughts and experiences and provide insight into their own difficulties. 

Comorbid diagnoses (multiple diagnoses) and more extensive history (e.g., development, school, psychiatric) are often present with adolescents and adults. Obtaining a clear and comprehensive history is important in understanding the individual’s strengths, needs, and life circumstances. Differential diagnosis is also critical. Some characteristics of other diagnoses can sometimes mirror or look very similar to those of ASD (e.g., anxiety). As such, it is important to rule out other diagnoses prior to diagnosing ASD or to assess the possibility of comorbid diagnoses.  We want to get the diagnosis right so we can get the treatment right. And we do not want to miss something, as that may impact response to treatment moving forward.

Is it too late to get an evaluation?

I get this question a lot in regards to conducting evaluations with adults. And I actually love getting this question because it gives me an opportunity to talk about something that I feel incredibly passionate about. It is NEVER too late to get an evaluation. It is never too late to get an evaluation because it is never too late to gain a better understanding of personal strengths and needs, and the underlying cause of some of those difficulties experienced over the course a lifetime. We could all benefit from that. And it is never too late to have support, to not feel alone, and to learn strategies that make life a little easier. 

I once had an adult who received her ASD diagnosis at age 65 tell me it was the best gift she had ever received because it was the first time she had ever felt at peace in her life. She understood herself and her difficulties better and could view these differences/difficulties through a different and more compassionate lens, instead of her previous more negative, self-blaming lens. Don’t we all deserve that, regardless of age?

What if it’s not autism?

Sometimes individuals arrive at my door, we conduct an evaluation, and they do not have ASD. I am always grateful they came to see me and we could rule out ASD. I think people worry about wasting their time or my time. In my opinion this is never a waste of time. Because ruling out ASD allows us to better understand and assess what else may be going on, such as anxiety, depression, or ADHD, etc. And this is ultimately, regardless of diagnosis, what is going to help an individual move forward and access the support they need.

 Why get an evaluation? 

Again, people show up in my office for many different reasons. The journey they have taken prior to getting to me varies greatly, as such, the “why” behind getting an evaluation is variable and dependent on that person. However, an underlying theme for most of the people that I have the opportunity to meet, is a sense of feeling lost, feeling like something is off, and feeling unsure about next steps, and what to do to make things better. That is not a good feeling for anyone. An evaluation should not only have a goal of identifying appropriate diagnoses; an evaluation should lead to individualized, concrete treatment recommendations. An individual should leave an evaluation, not with all the answers, not with everything suddenly fixed, but with a sense of direction and next steps. Isn’t that what most of us are looking for in life? Direction. A sense of empowerment and control. And hope. Hope that things can get a little easier. 

Posted in Articles, Autism.