Formal assessment

Well, my assessment was yesterday. I still have to wait a couple of weeks for the results appointment. But at the end of the session, the assessor person told me she thought I’d very likely get a diagnosis.

Since the assessment I’ve been doing lots of research about the diagnostic tool that was used, the ADOS (Autism Diagnostic Observation Schedule). It’s been very interesting to find out what the ‘expected’ responses were and how I compared.

Note: If you are expecting a formal assessment soon that might use the ADOS, I would recommend you don’t read the rest of this post. The assessment will be more accurate if you don’t know much about what to expect.

There were several activities involving objects and tasks. I assumed that they were the end in themselves, but of course it turns out they were just opportunities for the assessor to look for certain social behaviours. How very autistic of me to be so focused on the task at hand that I forget what the actual purpose was!

The first task was a simple puzzle. There was a laminated sheet with the outline of the completed shape, and then a set of foam pieces which were all the same shape, to be fitted together. When the assessor gave it to me, she gave me only a few of the pieces and said “Let me know if you need any more bits and bobs”. I thought it was weird that she didn’t just give me all of them straight away, but I didn’t even consider the fact that it might have been deliberate (my mum pointed it out afterwards!).

The task was actually supposed to see how I asked for the extra pieces. I was quite focused on the aim, so I don’t fully remember how I asked. I’m pretty sure I didn’t make eye contact, I think I just said something short like “Can I have some more pieces?” I remember that when I asked for more, she didn’t give me all of them – so I had to ask a second time to get the last ones. At that point, she said something like “It might need all of the pieces”, and I think I just said “Yeah” because – it obviously needs all the pieces!

Another task was to tell the assessor how to brush her teeth, imagining that she had “forgotten how to do everything”. When I looked this up, apparently the instructions are to “show and tell” – and the task is supposed to test how well you use gesture in combination with words. I can’t remember whether the assessor actually used that phrase, but if she did I must have ignored it. I told her using almost exclusively words. The only gestures I used were when I moved my hands in order to remind myself which parts I was talking about – and to check which hand was left and right so that I said the correct one.

Then I had to make up a story using some objects. The assessor got out a box full of things, and then chose five and told her own story with them. Then she told me to choose five of my own and tell a story. I chose a Rubik’s cube, a small red wooden cube, a black feather, a block of white foam, and a purple spiky ball. I had trouble thinking of any ideas for the story. The first thing I said was “This is a baby cube and this is the parent cube” to describe the Rubik’s cube and the red block. It seemed logical because they were the same shape but different sizes.

Then I said “They’re playing catch with the ball” and showed the purple ball moving between them. Then I couldn’t think of what to do next but eventually I said “this is a baby block as well, but it’s older” about the foam block – because it was a sort of in-between size (but not actually a cube). Finally I added the feather and said “This is like a bat, and the baby uses it to hit the ball”. Then I said that was the end. It wasn’t much of a story. When I looked it up, I found that it was testing your ability to assign personalities to objects (which I guess I… sort of did?), and your ability to make a story with a beginning, middle, and end (which I… definitely did not).

The next task was to tell the story from a picture book with no words. The assessor told the first few pages, then gave it to me to carry on. I noticed that she seemed to talk more about intentions and emotions, “The frogs want to go that way,” “The frogs are having fun”. When I carried on, I just described what was happening in each individual picture, “They’re going over some houses,” “They hit a washing line,”. (Yes, the story was about flying frogs). I didn’t really make any connections between the pictures or create an overall story from it.

The last activity was to describe a picture. I was given a laminated sheet that had a photograph of a piece of embroidered fabric showing a scene. I described what I could see in the scene – “There are lots of people around a table and it has food on it.” Then I tried guessing what the scene might be “It looks like it could be a party. Maybe a birthday because there’s a cake, although there aren’t any candles on it.” The assessor asked me where I thought the picture was set, and I said I couldn’t tell because all the people looked different. Then she said something like “It looks like it’s made of fabric. I’ve always wanted to get into quilting like that”.

I thought that was a kind of weird thing to say – why would she start talking about herself in the middle of an assessment about me? So I just ignored it and kept looking at the picture to try and think of more description to add. When I looked up the ADOS, I found that the assessor talking about herself was supposed to be a ‘cue’ to get me to chat. Apparently I was expected to ask her more about it or say something in response.

The rest of the assessment was mostly an interview, with questions about things like emotions and relationships. She asked what things made me happy/sad/angry, which I found really hard to answer. I said I thought being happy was something that seemed to happen more randomly, rather than as a result of specific events. And she asked me to describe how certain emotions felt, which I also found really difficult.

We also talked a lot about childhood, things like difficult making friends and having restricted interests. My mum said that there have been times where I get obsessed with something and don’t want to talk about anything else – she listed lots of examples, past and present. I found that interesting, because I thought that I was pretty good at ‘hiding’ my obsessions. I mostly just want to think about them alone anyway, so I thought I didn’t usually get into talking about them that much – but apparently I do!

It was a very interesting experience, and it wasn’t as stressful as I thought it might be. At the end, the assessor told me she has to get all the information together and consult with a colleague before she can agree on a diagnosis. I gave her a printed list of traits which I had annotated, and she said that would be very helpful. Now I just have to wait until the 11th for the results appointment.

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5 thoughts on “Formal assessment

  1. Wow, that’s really interesting! My assessment was nothing like that, but I imagine if it had been I’d’ve been much the same as you. My assessment was more like an interview with me and my mum, and they got the same information out of it but less practically/observationally.

    Thank you for sharing. :)

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    1. My assessment was really in two halves. The first half was an interview with me and my mum, more like what you describe. The second half was the ADOS. I had more interesting (and amusing!) anecdotes from the ADOS part just because there were more strange and specific tasks in it. :)

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        1. There are so many different types of assessment and interview and whatnot, because there’s no ‘objective’ way to do it. So I guess individual clinicians (or the people in charge of treatment in a certain area) just decide whatever they prefer. :S

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