Navigating Autism & ADHD Assessments
50-70% of Autistic people also have ADHD (National Institutes of Health).
This means that we need to work harder to better understand Autism, ADHD, and AuDHD so that we can improve the ways we support our kids!
As SLPs, it’s important for us to understand these characteristics so that we can support parents in seeking additional neuropsychologist assessments.
In order to better understand the assessment process, especially from a neuroaffirming perspective, we sat down with Dr. Karen Wilson who is a renowned clinical neuropsychologist and the founder of ChildNEXUS.
Here is a brief excerpt from our interview with Dr. Karen Wilson:
Jessie: How does a child land in your office? What's the typical age of children that you see and what kind of struggles are these children having that ultimately led them there?
Dr. Karen Wilson: Yeah, that's a great question. It actually is a wide range. I can have parents contact me when their kids are five, sometimes even three, and I'd say it's too early for me, but five for sure. And then all the way up until high school. Sometimes the first assessment is high school because the academic demands have increased and a child who never struggled before is suddenly struggling and so, you know, parents will often come because either their child is struggling at home, at school, on the playground, on the soccer field, and they don't know why.
They also don't know how to support them. And they want to better understand why their child is struggling. And some parents are afraid to get the assessment because they don't want their child to be labeled. And I always say it's not about getting labeled. It’s about understanding what is hard for them and why. We want to have a better understanding of why school is hard for your child, why making friends is hard, why they're struggling to follow directions that their coach is giving them, etc.
Jessie: Yeah, it's actually really interesting you say that because parents go into their assessment with you knowing that that is the possible outcome. And I think that's different in speech because families will come to us thinking like, I'm just giving my child the support they need.
And then sometimes that leads to a road of we need more assessments and more diagnosis. And that's sometimes a really hard conversation for us to have with parents because they're not ready for that. And but that's interesting because the people who come to your office, it's like they've already determined that.
Dr. Karen Wilson: Yeah, for them, they know that something is going on and they just don't know why. Right? They don't have the answers, you know, and they may even have some ideas in their head. And they're wondering, you know, is this anxiety, is this an attention struggle? Is this that they're not just they're just not interested in school? And so, again, they really want to understand why.
Chris: Yeah, absolutely. I think that I've heard, too, from a lot of individuals that have received a diagnosis and in the later years that have felt a sense of relief in a way, because they realized when they reflected back on their childhood, hey, my I had differences. I had a different neurological makeup and I'm not a broken neurotypical. I am a perfectly okay Autistic individual, but they wish they would have had some more information when they were younger, so that way they can understand what those differences are and how to navigate some of the challenging situations too.
Dr. Karen Wilson: That's exactly it. And I think some parents are afraid of the process itself, you know, And there's a mystery behind it, you know, what does it exactly involve? You know, are you going to be hooking up electrodes to my child's brain? How are you going to, you know, determine this? And it’s important that they understand that they are part of this process.
The assessment process has to be collaborative. You have to engage the parents. You have to understand what is their goal for this assessment process. What do they want to know? And then you can't leave the child out of the assessment process, Right? You have to involve them. You have to, you know, approach it with compassion, with empathy, with understanding and with curiosity.
Chris: Yeah, absolutely. I'm curious to know, because there has been a change from when in my childhood growing up and, you know, getting diagnosed with ADHD. Right. And then me, you know, happening to get into a field, working with kids with disabilities and there being this distinction or a separate categories of ADHD and then autism and then, you know, up until the past ten years.
But prior to that, they weren't never grouped together. Have you seen a little bit more of that where you're seeing that there's that ADHD profile in addition to autism?
Jessie: And to follow or to expand on that question,t I see a lot is people were diagnosed with ADHD as a child because autism was a lot harder for people to understand and see signs of. So they didn't get that diagnosis.
Instead, they got an ADHD diagnosis as a child and then as an adult they're getting an autism diagnosis. And is that because they are both autistic and ADHD, or is that because, you know, in the past, evaluators have had trouble distinguishing the differences?
Dr. Karen Wilson: Yeah, I think it's a little bit of both because I've seen the reverse where individuals have an autism diagnosis first and then they're struggling with attention in the classroom. And the ADHD was never also identified. Right. And I think there's some overlap in the traits in autistic individuals, individuals with ADHD. And so it's hard to distinguish the times.
And because the spectrum is so broad, you can have individuals who are just better at masking, you know, ADHD traits and the attention issues come up and they're manifesting and they're having more problems in that area. So it's easier for people to identify it. But up until, you know, a little over ten years ago, you could not diagnose ADHD in individuals with autism because they thought the symptoms were part of being autistic.
Chris: Yeah, absolutely. You know, back in the day, my caseload consisted of like just a couple students that were autistic, but it was kind of not really talked about because I think society had so much of a stigma, you know, based on that.
Whereas now I think we still have a long way to go. But I think that the stigma is slowly continuously being reduced, which helps people better identify and families being more okay with, you know, getting seeking evaluation and diagnosis as well.
Dr. Karen Wilson: Absolutely. And I feel like part of the reason they took out the idea that you could not also diagnosed ADHD in autistic individuals is because that denies the treatment and the support needed for the attention struggles. You have to be able to address and provide them with all the supports that they need in order to thrive.
Jessie: That is so true. We need to be providing the right supports. So ultimately, how do you like untangle those differences between autism and ADHD when you are giving an assessment?
Dr. Karen Wilson: It really goes back to being collaborative, right? You're getting information from parents about early history. You want to know, what was this child like in preschool? Or kindergarten? And taking time to talk to the student about, you know, again, what things come easily for you and what things are harder for you.
And that helps us to tease apart kind of where the challenges kind of fall. And there can be both like we talked about, you can be autistic and have ADHD. And so we want to know again, what is that? What are the driving factors for individuals with ADHD? Again, the primary issue is usually attention and focus and executive functioning.
And for autistic individuals will often again have again be passionate about certain subjects and have a hard time kind of transitioning away from those. They can have difficulty navigating social arenas and understanding social nuances and reading nonverbal cues. You know, they can be paying attention to everything and can be overwhelmed by the sensory stimulation in rooms in a way that individuals with ADHD don't.
Anytime we're doing these evaluations, again, the goal is always to understand and there's so much overlap between, you know, behaviors and traits that unless you really do a deeper dive into why a child is struggling, you won't be able to provide the appropriate level of support.
This is just a tiny part of our conversation with Dr. Karen Wilson.
If you want to hear us go into the characteristics between Autism and ADHD, more detailed information about the assessment process, and the importance of getting an accurate diagnosis in order to make sure the right supports and accommodations are being put into place, then make sure you check out our interview with Dr. Karen Wilson on our YouTube Channel.
>> Making the Shift, Episode 69, Navigating Autism & ADHD Assessments ft. Dr. Karen Wilson
