Should I get a psychological evaluation to rule out ASD? (Part 1)

Questions like this one are very common in my circle. The main driver of this question is the underlying fear:

Is it possible to misdiagnose autism or ASD during early childhood?

The answer is: Yes, absolutely! To understand the how and why autism may be misdiagnosed, I think it is best to understand the process and the issues associated with it, so that we can better understand how to move forward.

Let’s look at the whole process, shall we?

What happens first?

One of the most difficult questions for parents to answer is whether they would like to receive a psychological evaluation for their young child. Even though this is a simple yes or no answer, the majority of parents that I’ve worked with are baffled or just simply confused by this question.  This is a question that parents may be asked at different times during the early intervention years.  Sometimes it occurs as early as during the initial meeting, before any services are even provided.  Other times, it is a questions posed by different member of the therapeutic team.  Sometimes, this question gets asked at multiple times by different people. 

But what does this mean?

A psychological evaluation done within the context of early intervention serves one main purpose:  to either diagnose, or rule out the diagnosis of ASD. Perhaps an evaluator suspected that this may be the case, and the questions gets asked at the initial meeting, or perhaps a therapist feels that a diagnosis is the best course of action, hence the question to the parents.

For the most part, when parents hear the words “psychological evaluation,” they become anxious. This happens sometimes because there isn’t enough time spent on explaining exactly what this means. Sometimes, parents themselves are too shocked to even ask any questions. And some other times, parents feel “pushed” to make a decision, shut down, and no longer ask questions.

In my almost 20 years as an early interventionist, I have seen the gamut:  I have seen parents whose children would benefit from an evaluation, but the parents did not consent to one, and I have also seen parents whose children were clearly not on the spectrum, but were pushed to get one.  The result?  Children with autism that do not get what they need right from the start, but also quite a few children without autism who receive diagnoses (or misdiagnosis) of ASD out of pressure and get therapies that are less than ideal for them.

What happens after the diagnosis?

What happens next typically depends on decisions made at family planning meetings after evaluations are completed.  In general, Applied Behavior Analysis is offered as a method, often, but not always, at the direction of a special instructor (a teacher trained in special methods and strategies).

Parents normally ask me about this type of methodology, wanting to know my personal opinion of this method. I often respond that the methodology need to fit the need. I often remark that even though a cold and the flu may look alike, only the flu gets an antiviral prescription, not the cold. Similar ailments do get different courses of treatment. The same is true of ASD and other conditions.

I’m not sure, what should I do?

If you are not sure, sometimes it pays to wait just a few months (2, 3 or 4, but no more than 6), and observe your child. Consult with your team. Read up on the subject. Talk to family. Let the current intervention work. Do all the carry over homework that your team suggests you do.

But most importantly, listen to yourself. Listen to your heart. I always listen to the moms and dads I work with. They are my BEST RESOURCE!

Stay tuned for more information. And as always, leave me a note with any questions.

Boy sitting holding a pink toy

Cheers!

Dr. Klimek

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