Criteria Not Met

[Bernadette]

Hi all,

I am a mother of 2 boys. My youngest was diagnosed last year ASD Level 2 and a mild cognitive impairment. My eldest is 8 and I've suspected since he was 1.5yrs that he may also be autistic.

Background: late speech and language, had no interest in peekaboo, pattycake games etc. No interest in waving bye. He smiled as a baby and laughed. But as a toddler and child he doesn't very often at all. He has no social reciprocity with us, people he knows let alone strangers. If we leave school for example, and we pass a friend of his who said goodbye, he walks past and doesn't say anything back or wave.

We had an ASD assessment through our local universitys psychology clinic. It was conducted by a Provisional Psychologist and overseen by her supervisor.

His SRS questionnaire showed "severe" traits. ADI-R met cut offs for all domains. And he scored a 12 on his ADOS. However, the 12 was only in

Scores:

1. Language and Communication (reporting of events, conversation, use of gestures) = 0
2. Reciprocal Social Interaction = 12 (this section included items such as having unusual eye contact, lack of facial expressions directed to examiner, amount of shared enjoyment in interaction, and amount of reciprocal social communication)
3. Stereotyped Behaviours and Restricted Interests = 0

You will see scores of 0 above, however as mentioned this is based on the AODS-2 algorithm and does not mean he didn’t score any points in these areas overall.

They said that because he was able to show some gestures in a follow up play based session with the psych and her supervisor after the ADOS assessment - such as thumbs up, showed how big his dogs were with his hands etc and when the supervisor mentioned what her favourite food was and then asked him what his favourite food was. After a period of time, he eventually asked the psychologist what her favourite food was. They felt he didn't meet all of the criterias and therefore was not diagnosed with ASD.

I don't know how to feel about this, as I disagree as this does not come naturally at all for him asking questions and he may have felt some form of pressure to ask. Is it worth getting a second opinion?

 

[Magna]

Yes, I would get a second opinion. Are you in the U.S.? If so, have you considered having the public school system assess your son? They must do that for free in order for a child to be eligible for an IEP.

 

[MyLifeAsAnAspie]

How did he come to get assessed. Was it on your initiative or a recommendation by doctor, therapist or school? Did they have another diagnosis or recommend further evaluation?

 

[Neonatal RRT]

A second opinion is likely needed. Specifically, inquire about how the testing is performed. Psychologist interviews are just one aspect. I did about an hour of interview, another hour of cognitive performance testing in a lab with a person leading the testing, another being an observer noting things like response times, body language, etc. I did yet another hour of written testing. My wife was also interviewed while I was in the testing lab.

 

[Tom]

Yes

 

[Bernadette]

Yes, I would get a second opinion. Are you in the U.S.? If so, have you considered having the public school system assess your son? They must do that for free in order for a child to be eligible for an IEP.

No, we are in Australia. It's next to impossible to get an ADOS done for free. This one cost us $700 as it was performed by a provisional psych and overseen by a clinical psych.

 

[Bernadette]

How did he come to get assessed. Was it on your initiative or a recommendation by doctor, therapist or school? Did they have another diagnosis or recommend further evaluation?

I self referred based on my own instinct, I've also had a previous teacher and teacher aide gently mention the possibility of him having ASD. Also family members who've mentioned it as well. No other diagnosis, just that perhaps it's anxiety.

 

[Bernadette]

A second opinion is likely needed. Specifically, inquire about how the testing is performed. Psychologist interviews are just one aspect. I did about an hour of interview, another hour of cognitive performance testing in a lab with a person leading the testing, another being an observer noting things like response times, body language, etc. I did yet another hour of written testing. My wife was also interviewed while I was in the testing lab.

We had an initial intake with her. She then did a cognitive assessment with him. I then came back and did a Vineland with her and ADI-R. Then he came back for an ADOS with her while the clinical psych and an OT observed through a mirror. Then they had him come back again for a play based session. So in total, he'd had 3 sessions with her.

 

[MyLifeAsAnAspie]

I wonder if they are prejudiced by the lack of a referral from a doctor or school. If you are confident of the answers you gave to the interview questions, then maybe they did get it wrong.

When my daughter was about that age, a psychiatrist saw her and didn't recommend she get evaluated. Although, this was awhile ago, under DSM-IV, I think he was not current on the spectrum even as it was seen then. He actually wrote, that "her eye contact was too good" as a disqualifier. She did later get some related diagnosis and then an ASD-1 at 18yo, using the tests your son had.

 

[Bernadette]

I wonder if they are prejudiced by the lack of a referral from a doctor or school. If you are confident of the answers you gave to the interview questions, then maybe they did get it wrong.

When my daughter was about that age, a psychiatrist saw her and didn't recommend she get evaluated. Although, this was awhile ago, under DSM-IV, I think he was not current on the spectrum even as it was seen then. He actually wrote, that "her eye contact was too good" as a disqualifier. She did later get some related diagnosis and then an ASD-1 at 18yo, using the tests your son had.

Yes, I feel like they negated some of his symptoms as well when matching to the DSM criteria. I told him he is sensitive to loud noises and doesn't wear certain clothing, struggles with the feeling of socks to the point he is in tears over how uncomfortable they are. But then said he has no hypo or hyper sensitivity. I'm going to take the report to a paediatrician and see if it's worth having him reassessed elsewhere.

 

[Magna]

I wonder if they are prejudiced by the lack of a referral from a doctor or school. If you are confident of the answers you gave to the interview questions, then maybe they did get it wrong.

When my daughter was about that age, a psychiatrist saw her and didn't recommend she get evaluated. Although, this was awhile ago, under DSM-IV, I think he was not current on the spectrum even as it was seen then. He actually wrote, that "her eye contact was too good" as a disqualifier. She did later get some related diagnosis and then an ASD-1 at 18yo, using the tests your son had.

My son has good eye contact a lot of the time. We're both autistic and it's funny because his eye contact is 10 times better that mine is. Going by eye contact or lack thereof alone, he'd not be diagnosed with autism. Ignorant of that psychiatrist. My son was diagnosed with ASD at the Autism Society (we paid for it) and then also diagnosed independently with ASD by the school system in which the assessment processes was extensive and involved a whole team. Point being, not all autistic people have difficulty with making eye contact.

 

[Bernadette]

My son has good eye contact a lot of the time. We're both autistic and it's funny because his eye contact is 10 times better that mine is. Going by eye contact or lack thereof alone, he'd not be diagnosed with autism. Ignorant of that psychiatrist. My son was diagnosed with ASD at the Autism Society (we paid for it) and then also diagnosed independently with ASD by the school system in which the assessment processes was extensive and involved a whole team. Point being, not all autistic people have difficulty with making eye contact.

Yes, in my son's case he has limited eye contact and facial expressions. But they said he didn't meet the criteria in A2 because he was able to gesture..