***We specialize in assessing autism and co-occurring mental health difficulties***
The autism assessment program at TAP was developed out of a recognition that autism was frequently being missed in many clients seeking therapy in our clinic. On our journey to better understand and recognize autism, we came to understand the significance of undiagnosed autism in creating an effective treatment plan. We also realized that many of our clients had experienced diagnostic overshadowing, meaning they had been given diagnoses in the past - some of which were likely accurate - but that they had not received an accurate diagnosis or characterization of their neurotype. As such, we sought out expert training in autism assessment to help clarify these diagnostic questions.
These individuals often have one or more of the following attributes:
- Assigned female at birth (AFAB)
- Do not “seem” autistic to others (i.e., do not display many obvious or stereotypical signs to the outside observer)
- Strong verbal communication abilities
- High intellectual functioning
- Have had few or no academic problems in school, especially in younger years
- Work hard to “mask” or imitate the social norms and behaviors others expect
- Identify as transgender or non-binary
- Identify as Black, Indigenous, or a person of color
- Have been given two or more other mental health diagnoses
- Have a history of self-harm or suicidality
- Have been in multiple forms of mental health treatments and seen less progress than expected
- Appeared to be doing well until around middle school when suddenly more social challenges and mental health symptoms appear
In the past decade, the field of psychology has seen a dramatic improvement in our understanding of how autism presents in a much wider range of individuals. Overall, our previous understanding and processes for identifying autism were heavily focused on the way in which autism presents in those assigned male at birth and in presentations that more obviously required substantial supports in tasks of daily living. As a whole, these individuals typically had more overt signs of autism that were more recognizable at younger ages. Research has now found that those assigned female at birth are more likely to be diagnosed later in life than males and be given other mental health diagnoses first. Additionally, these individuals are more likely to be misdiagnosed with conditions such as borderline personality disorder and bipolar disorder.
Individuals with autism, especially when not identified and receiving the proper supports, are more likely to experience the following:
- Anxiety and obsessive compulsive disorder
- Depression and self-harm/suicidality
- Difficulty with emotion regulation or impulsive behaviors that may cause problems at school or home
- ADHD and executive functioning challenges
- Difficulties with eating and sleeping (e.g. insomnia, restricted eating, highly selective eating)
- Gastrointestinal challenges such as Irritable Bowel Syndrome
- Chronic pain and/or fatigue
In our experience, often it is these challenges that initially bring individuals to treatment and they often do not respond to many treatments as expected or continue to have evolving challenges as long as the underlying autism is not properly identified, understood, and incorporated into treatment planning. To learn more about why proper identification is so important for treatment, click here.
How do you assess for autism at TAP?
Our autism assessments include:
- clinical interview of the patient
- collateral interview when possible (e.g., a partner or parent)
- self- (and, for youth, a parent) report forms
- structured evaluation of social language development
- teacher/school report (for youth)
- direct observation using the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2)
- measures designed to assess for efforts put into “masking” or camouflaging autistic traits
Given the range of common misdiagnoses and co-occurring experiences, our autism assessments often involve complex differentials to determine what best explains an individual's experience. As many of our assessors hold advanced training in Dialectical Behavioral Therapy (DBT) and exposure-based treatments, we are uniquely qualified to assess and understand the function of avoidance, self-harm, suicidality, and dysregulated behavior.