Help me think about what to say to psychiatrist and to my kid- 1st visit

[SKL]

Howdy.  My dd13's first psych visit is mid-day today.  I am drawing a blank re what to tell her in order to get our concerns addressed.

The reason I set the appointment was that back in December, my daughter's [presumed] OCD symptoms were getting to the point of interfering with normal daily life, such as getting out the door in time for school in the morning, paying attention / keeping up at school, etc.  She had developed fears and rules/rituals for dealing with them.  She also has a history of a variety of issues that are less severely disruptive, but still concerning enough to be looked at.

Since Christmas vacation, she's been doing much better, though still having symptoms.  She does agree that she needs to go to the doctor and figure things out.

One thing I did not mention to my daughter is that besides OCD and anxiety, I suspect ASD in the mix.  I want her to have a complete physical and neurological examination or whatever that's called.

I find this difficult on so many levels.  My kid is functioning well in so many ways.  I'm proud of her and I want her to feel that.  I don't want her to feel like she's broken and needs fixing.  But I really feel she's being held back from meeting her potential.

In the past, doctors have blown off my concerns or tried to label them as ADHD.  I need to make sure this visit is productive and somehow positive.

Suggestions?

[Tap]

I would want to let the doctor know that you see some struggles in her everyday life, that prevent her from living her life freely.  Maybe offer a couple simplified examples. Illustrate how she is working hard on her own to make some changes, and that she has had some great successes. 

I would let the doctor know you are looking for testing and related strategies for your daughter that can help guide her to find some coping strategies that are less invasive on her life, than what she is currently doing. I would let them know some strengths as well as struggles. 

I would emphasis that you adore your daughter, see her as a unique and beautiful person. You are looking for ways for your daughter to understand which traits may be OCD or ASD related, and how your daughter can learn to manage them. I would emphasis that you want you work alongside your daughter to support her through the entire process. Let them both know that you understand that sometimes it may mean a one-on-one role and other times, it may mean taking a hands off approach to let your daughter discover what is best for her.  

You don't have to outline every little detail in the first meeting. Just the basics of what you are looking for and that you are there in a supportive and encouraging role. 

[leahtalbot96]

Just give them a general summary of her issues. 

Perhaps ask about coping techniques as well? 

[Ottakee]

I would write it all down....concerns, what led to appointment, what is better now, what is worse, what strategies you have tired, any meds, etc.  Include sleep and eating, social concerns, strengths, etc 

It is SO easy to forget key things when you are actually there.  Often there are forms for you and Dd to fill out, etc.

If she hasn't had one recently, a physical with blood work, urinalysis, etc is spot on.  Our psychiatrist ordered that and we found anemia, low thyroid, and a low grade bladder infection along with low vit d.  My DD STILL needed meds but treating those underlying things was so important to overall health.

[Pawz4me]

I'd type it all out. I'd have bullet points in bold and then expand below those if/when necessary. You want the highlights in bold to catch her attention as she skims it, so she can ask questions if necessary. You can list what you see as your DD's problems, as well as her strong points. At least for me, writing things down helps organize my thoughts. And a written report from the parent gives the clinician something permanent to put in the child's file for reference. It sounds as if one thing you want (definitely) is psycho-educational testing. That's typically done by a psychologist. She can probably refer you to one.

[Lanny]

IMO your DD is extremely lucky that you were able to arrange an appointment with a Psychiatrist for her. The appointment will be very short. I would NOT try to tell the Psychiatrist what to do, with regard to testing/examinations of any kind, medications, etc.. She can order any examinations she believes might be helpful. As others have suggested, I would have some notes so I don't forget the most critical issues of concern. Good luck to your DD!

[Storygirl]

I also write things down in detail before intake meetings like this. Not only as a reminder to myself, but also so that I can give a copy to the psych.

I can see why you think it's uncomfortable to bring up ASD, since you haven't discussed it with your daughter yet. Talk to her about it on the way to the appointment. You can explain that some traits of OCD are similar to traits with autism, and it takes someone really knowledgeable to sort it out. And that sorting it out will help her figure out how to handle things better. And that no matter what kind of diagnosis she might get, that it doesn't change who she is; it just gives her more information about herself.

You do need to ask directly about ASD for the doctor to know that is one of your concerns. Ask what specific tests they might use. There are a few important things for you to know about diagnosing autism. First, for people who might be on the line, there are some who will NOT diagnose, while others would diagnose, so borderline cases can be tricky to get diagnosed. Secondly, girls can be harder to diagnose.

Thirdly, psychiatrists are not typically the people who specialize in diagnosing autism. It's more common, I think, to go to a psychologist or a neuropsychologist or a developmental pediatrician, or an autism center at a hospital that uses an approach involving a team of specialists. Going to a psychiatrist is a GOOD FIRST STEP. But they might not be the best person to sort out the autism issue for you. If this psychiatrist says they don't suspect autism, I would not take that as a final answer, personally.

For a definitive answer, you would like someone who takes a full history from you about past concerns, going all the way back to when she was a baby. Part of the diagnostic criteria is that there were indications of issues very early on, even if those symptoms are not presently a problem. For example, early speech development issues, early signs of sensory differences, delays in the child's ability to play and connect with you or others when a toddler (for example, obsessive interests in particular toys or playing alone instead of interacting with people).

After the full history, an autism evaluation ideally should include a test called the ADOS. You want to ask about this specifically and also ask how much experience they have with evaluating girls or what they look for in girls that is different than what they would see in boys.

If they say they use a screening tool called the GARS -- which is a questionnaire for the parent -- know that many do not consider the GARS to be reliable enough. (The GARS missed diagnosing my child, who was found to be autistic using the ADOS, and that is not uncommon at all, which is why I mention the GARS specifically as one to be leery of).

If you do not feel satisfied that you will get a full answer on the autism question from this psychiatrist, please PM me, and I can give you an idea about where else you might go. It's possible to have BOTH autism and OCD or anxiety. You might get an answer about the OCD question from a psychiatrist and still have to go to someone else to decide about autism. It's very common to have to see more than one specialist to figure things out.

I think this is a great first step!! Just don't be surprised if it does not give you the full picture.

[Storygirl]

26 minutes ago, Lanny said:

IMO your DD is extremely lucky that you were able to arrange an appointment with a Psychiatrist for her. The appointment will be very short. I would NOT try to tell the Psychiatrist what to do, with regard to testing/examinations of any kind, medications, etc.. She can order any examinations she believes might be helpful. As others have suggested, I would have some notes so I don't forget the most critical issues of concern. Good luck to your DD!

All of the intake appointments I have been to for my kids have been long. An hour or more.

Edited February 24, 2020 by Storygirl

[73349]

Just FYI, I've been told that because Anxiety Not Otherwise Explained is a component of an ASD diagnosis, they will need to treat OCD (an anxiety disorder) before addressing potential ASD anyway. So I would focus on the OCD symptoms for now.

You and your DD might like the book What to Do When Your Brain Gets Stuck, although it's written for slightly younger kids.

[OH_Homeschooler]

6 hours ago, SKL said:

I find this difficult on so many levels.  My kid is functioning well in so many ways.  I'm proud of her and I want her to feel that.  I don't want her to feel like she's broken and needs fixing.  But I really feel she's being held back from meeting her potential.

 

She's not broken. There are individual differences with regard to everything. Everyone has something they struggle with, and this just happens to be her something. And like you said, you see what she is capable of and you don't want her to be held back.

[Jentrovert]

Everything Storygirl said. My dd8 was dx'd with autism last year, by a psychologist. Based on similar advice on the Learning Challenges board, I took in over 6 pages of notes detailing behaviors over the years, comments by others, current behaviors, etc. I also drove over 7 hours in order to find a psych who had experience with both homeschoolers and girls. We spent 5 hours or so, broken up into two days, with over half of that being the intake interview talking over my notes and filling out questionnaires. She ended up dx'ing ASD1 and ADHD.

Maybe what psychiatrists typically do varies by area, but here I wouldn't expect a psychiatrist to dx autism. Around here, they mostly seem to be used mainly for scripts - people see a psychologist for the meat of it. 

We had previously read a book or two about autism, since we have friends on the spectrum (and I was laying the groundwork to talk about my husband wih the kids) so she had heard of it. Also, she had brought up the fact that her brain "just seems to work different than other people". So I told her that this visit was to help us better understand how her brain works and that it was likely her brain works similarly to Daddy's and our friends with autism. (I was pretty sure about it. Had I not been, I might have been a bit more vague.) 

Our language about it has always just been about differences, not better or worse. Everyone has things that are harder for them . . . this thing is hard for me, this other thing is hard for you. If we understand the differences, we can better work together. 

 

[PeterPan]

2 hours ago, whitehawk said:

Just FYI, I've been told that because Anxiety Not Otherwise Explained is a component of an ASD diagnosis, they will need to treat OCD (an anxiety disorder) before addressing potential ASD anyway. So I would focus on the OCD symptoms for now.

You and your DD might like the book What to Do When Your Brain Gets Stuck, although it's written for slightly younger kids.

If she went to a psychologist they would diagnose the ASD and not wait. The anxiety would be comorbid.

[PeterPan]

I agree the pdoc is not your complete solution. You need a full psych evaluation, preferably by someone who sees a lot of autism and girls. Love that @Jentrovert made that effort. Makes s huge difference. 

Evals do feel like you’re dissecting and breaking them up, but you put them back together in the end. The RESULT will be a better picture of the whole child.

Most people feel RELIEF when they get their diagnoses. Don’t be afraid of it. Having the right words for what she feels will help.

Edited February 24, 2020 by PeterPan

[wathe]

10 hours ago, SKL said:

 

 

I find this difficult on so many levels.  My kid is functioning well in so many ways.  I'm proud of her and I want her to feel that.  I don't want her to feel like she's broken and needs fixing.  But I really feel she's being held back from meeting her potential.

We all have differences.  I like to use the example of eyeglasses with my kids:  Some people's eyes work differently, and they use a tool (eyeglasses) to help them function in the modern world.  Similarly, some people's brains work differently, and they use tools (meds, therapy, structures like check-lists, schedules, reminders, alarms) to help them function in the modern world.  Like eyeglasses for your brain.

[Rosie_0801]

3 hours ago, OH_Homeschooler said:

 

She's not broken. There are individual differences with regard to everything. Everyone has something they struggle with, and this just happens to be her something. And like you said, you see what she is capable of and you don't want her to be held back.

 

Yup. Brains do weird stuff, often without asking. It's not a character flaw.

My daughter recommends 'Some Brains' by Nelly Thomas. (I honestly thought she'd find it a bit babyish, but she seems to find it comforting and rereads it often.)

[Lawyer&Mom]

10 hours ago, SKL said:

One thing I did not mention to my daughter is that besides OCD and anxiety, I suspect ASD in the mix.  I want her to have a complete physical and neurological examination or whatever that's called.

I find this difficult on so many levels.  My kid is functioning well in so many ways.  I'm proud of her and I want her to feel that.  I don't want her to feel like she's broken and needs fixing.  But I really feel she's being held back from meeting her potential.

You can tell her that there are lots of undiagnosed girls out there, who are doing well, but who could still use additional supports to make their lives easier.   You can also tell her that there are Autistic adults who are married, and have kids and careers.  A diagnosis will help her reach her life goals, whatever they are.  It doesn’t mean she is broken and needs fixing.  
 

(I was diagnosed at 39. I wish I had been diagnosed at 13!  Getting supports in place before college would have been fantastic.)

Edited February 24, 2020 by Lawyer&Mom

[kiwik]

I am not diagnosed but pretty sure I am.  Ds10 finally got diagnosed last year.  It took 6 years of harassing the system but once he finally got approved to see the psychologist he was pretty sure straight away but ran the ADOS to check.  I do wish I had got to see him 6 years ago but I guess 10 is better than 16.  I think if I had got a diagnosis as a child it would have been a relief as I would have known that actually it wasn't that I didn't try hard enough or had a character flaw just that I was wired differently.

 

Ds10 is highly gifted and does present more like a girl with ASD.

Edited February 25, 2020 by kiwik

[leahtalbot96]

On 2/24/2020 at 8:36 AM, SKL said:

I find this difficult on so many levels.  My kid is functioning well in so many ways.  I'm proud of her and I want her to feel that.  I don't want her to feel like she's broken and needs fixing.  But I really feel she's being held back from meeting her potential.

 

OP, she is not "broken". Everyone needs help with something. If she was "broken" then my physically disabled 3 year old is also "broken". All of us are different even those who have difficulty with this or that. This is the example I used in a recent discussion with my six year old sister who wanted to know why my son* is a full time wheelchair user. Some people find it difficult to walk due to paralysis so they have to use mobility aids like a wheelchair instead, or braces to walk but it does not mean they are "broken", far from it in fact.  

*He has open defect spina bifida, it is a T12-L1 lesion. 

[kiwik]

Not getting the diagnosis and support you need is what makes you broken.

[Storygirl]

@SKL I hope the appointment went well!

[Scarlett]

@SKL Thinking about you and your Dd This morning.

[leahtalbot96]

@SKL I hope the appointment goes well! I have been to many appointments over the past three years, and my first piece of advice is to take something to read or do with you beforehand in the waiting room. Also I recommend taking a list of questions to ask the doctor as well. 

[ScoutTN]

SKL, how did it go?

[Jentrovert]

I've been thinking about your dd this morning. Hope the appointment was productive.

[katilac]

On 2/24/2020 at 2:36 AM, SKL said:

I don't want her to feel like she's broken and needs fixing.   

Most of the younger generations have much less angst about therapy and such than we do. iirc, your dd may have had some resistance at some point? but, in general, I find the meme below to be spot-on. 

[SKL]

HI guys!  I haven't had a chance to get back here since yesterday morning.

I felt the appointment went really well.  The doctor talked with us (mainly my daughter) for nearly an hour.  She asked the most on-point questions, and my daughter was so glad to feel understood.  We both really liked the doctor.

I did speak to my daughter on the way to the appointment.  Although I didn't get a chance to write anything down, I made time to discuss my thoughts with dd in advance and encourage her to articulate hers, which she did pretty well during the appointment.  Although I don't disagree with writing things down, I did try that before and it kind of backfired, as my kid took issue with what I wrote.  I felt it was better to get her to do as much of the talking as possible.

I did insert a few thoughts.  I mentioned girl ASD and her long history of sensory issues.  Apparently the childhood sensory issues are somewhat of a red flag for OCD.  Who knew?

The psych says she is 99% sure it's OCD.  She gave us a referral to a psychologist who specializes in a kind of therapy for OCD.  She also assigned us to read a book, "Talking Back to OCD."  After 6 sessions with the psychologist, she wants to see dd again to see if that helps, and decide what, if anything, to do next.

So yeah, this was a good first step.  Not going to lead to comprehensive testing any time soon, but I still feel positive about it.

[Lawyer&Mom]

This sounds really positive.  It’s so important to feel heard and understood.  Always makes me feel much more confident in a diagnosis (or non-diagnosis) if I feel the doctor “gets” me or my kid.  Good luck with the process going forward!

[Jentrovert]

I'm glad it went well! 

[PeterPan]

3 hours ago, SKL said:

I mentioned girl ASD and her long history of sensory issues.  Apparently the childhood sensory issues are somewhat of a red flag for OCD.  Who knew?

Saying OCD does not exclude ASD. The only way to examine that question is to get someone who specializes in girls with ASD and let them do their thing. They'll do an ADOS, lots of developmental intake, and spend a lot of time. 

You're talking about things that overlap both symptomatically and genetically. Here's an article on the comorbidity to get you started. obsessive-compulsive disorder - Spectrum | Autism Researchwww.spectrumnews.org › features › deep-dive › untangling-ties-autis...  

Did the pdoc suggest medications? Just wondering. Like not that I care or have a stake. I'm just kind of surprised that it was all about cognitive strategies and no suggestion even of meds for anxiety. Oh so 6 sessions of cognitive and then decide?

Ok, the only reason I'm harping on this, is there's nothing more offensive than the implication that IF YOU WANTED TO BE BETTER YOU WOULD BE. And incomplete diagnoses and incomplete strategies are really prone to that. So I think that's the thing I'm flagging for here. Like you don't want her to feel broken, so I would be very cautious about someone who's willing to throw someone into cognitive solutions (if you wanted to enough and tried to hard enough you wouldn't be this way) without COMPLETE evals. 

Complete evals would sort out your ASD question. They would allow her to acknowledge what portion is stimming, what portion is sensory overload, what portion is anxiety, what is OCD. They would acknowledge the sensory issues with an OT eval and work on her interoception. The self-awareness work they do for OCD (which I assume they would do!) would not be at the same *level* as someone with ASD would need.

But that's just your morbid, what could go wrong take. I hope it works great and she feels great about it.  

Edited February 25, 2020 by PeterPan

[katilac]

2 hours ago, PeterPan said:

  

Did the pdoc suggest medications? Just wondering. Like not that I care or have a stake. I'm just kind of surprised that it was all about cognitive strategies and no suggestion even of meds for anxiety. Oh so 6 sessions of cognitive and then decide?

Like you don't want her to feel broken, so I would be very cautious about someone who's willing to throw someone into cognitive solutions (if you wanted to enough and tried to hard enough you wouldn't be this way) without COMPLETE evals. 

 

 

Her dd is about 13; ime, it would be really unusual to go straight to meds. I don't think they necessarily have to even suggest meds at the first visit - the strategy of working through the book, having six sessions, and then talking about what to do next sounds sensible to me. Her dd is able to attend school and hasn't had any dramatic or extreme incidents. The therapist will get in touch with the doc if they feel it's necessary to consider trialing meds before then. 

I don't agree with your interpretation cognitive therapy at all. Teaching strategies to try does not equate "you could do this for sure if you tried hard enough." Genuine question: how do you feel cognitive therapy differs so sharply from the behavior therapy you use with your son? My very rough take would be that both are centered on teaching and practicing practical strategies to improve one's daily life. What am I missing? 

 

[hippiemamato3]

On 2/24/2020 at 7:18 AM, Lanny said:

IMO your DD is extremely lucky that you were able to arrange an appointment with a Psychiatrist for her. The appointment will be very short. I would NOT try to tell the Psychiatrist what to do, with regard to testing/examinations of any kind, medications, etc.. She can order any examinations she believes might be helpful. As others have suggested, I would have some notes so I don't forget the most critical issues of concern. Good luck to your DD!

A typical intake appointment with a psychiatrist is an hour or more. It is absolutely ok to ask the psychiatrist for specific testing if you have concerns. 

[hippiemamato3]

55 minutes ago, katilac said:

 

Her dd is about 13; ime, it would be really unusual to go straight to meds. I don't think they necessarily have to even suggest meds at the first visit - the strategy of working through the book, having six sessions, and then talking about what to do next sounds sensible to me. Her dd is able to attend school and hasn't had any dramatic or extreme incidents. The therapist will get in touch with the doc if they feel it's necessary to consider trialing meds before then. 

I don't agree with your interpretation cognitive therapy at all. Teaching strategies to try does not equate "you could do this for sure if you tried hard enough." Genuine question: how do you feel cognitive therapy differs so sharply from the behavior therapy you use with your son? My very rough take would be that both are centered on teaching and practicing practical strategies to improve one's daily life. What am I missing? 

 

Medication is typically needed for OCD, though there are people who manage without it. 

[katilac]

1 minute ago, hippiemamato3 said:

Medication is typically needed for OCD, though there are people who manage without it. 

Oh, I'm aware, we have a dx in the family, but very few docs are going to go straight to meds for a very young teen on the first visit. 

[SKL]

3 hours ago, hippiemamato3 said:

Medication is typically needed for OCD, though there are people who manage without it. 

The doc said that about 70% of people who work with a really good therapist can improve enough without additional interventions.  The other 30% won't.  She did say that most of the practitioners don't do the therapy right ... not her exact words, but ... she referred me to a guy who she says is the only one in our area who does it right.  We'll see.

My preference is to pursue non-chemical options if they might work.

[SKL]

7 hours ago, PeterPan said:

Saying OCD does not exclude ASD. The only way to examine that question is to get someone who specializes in girls with ASD and let them do their thing. They'll do an ADOS, lots of developmental intake, and spend a lot of time. 

You're talking about things that overlap both symptomatically and genetically. Here's an article on the comorbidity to get you started. obsessive-compulsive disorder - Spectrum | Autism Researchwww.spectrumnews.org › features › deep-dive › untangling-ties-autis...  

Did the pdoc suggest medications? Just wondering. Like not that I care or have a stake. I'm just kind of surprised that it was all about cognitive strategies and no suggestion even of meds for anxiety. Oh so 6 sessions of cognitive and then decide?

Ok, the only reason I'm harping on this, is there's nothing more offensive than the implication that IF YOU WANTED TO BE BETTER YOU WOULD BE. And incomplete diagnoses and incomplete strategies are really prone to that. So I think that's the thing I'm flagging for here. Like you don't want her to feel broken, so I would be very cautious about someone who's willing to throw someone into cognitive solutions (if you wanted to enough and tried to hard enough you wouldn't be this way) without COMPLETE evals. 

Complete evals would sort out your ASD question. They would allow her to acknowledge what portion is stimming, what portion is sensory overload, what portion is anxiety, what is OCD. They would acknowledge the sensory issues with an OT eval and work on her interoception. The self-awareness work they do for OCD (which I assume they would do!) would not be at the same *level* as someone with ASD would need.

But that's just your morbid, what could go wrong take. I hope it works great and she feels great about it.  

She did mention meds, but not as a first option.

Re ASD - she didn't rule it out, but just didn't want to try to address both at the same time.  I can kind of understand that, especially if there is a good chance that the OCD can be brought under control enough to see what else is there.

Wonder if I could get a copy of that "ADOS" or a summary of it.

[Jentrovert]

7 hours ago, SKL said:

She did mention meds, but not as a first option.

Re ASD - she didn't rule it out, but just didn't want to try to address both at the same time.  I can kind of understand that, especially if there is a good chance that the OCD can be brought under control enough to see what else is there.

Wonder if I could get a copy of that "ADOS" or a summary of it.

Just keep in mind, girls present differently and it's a known thing that the ADOS does not properly evaluate girls. Questions and scoring are based on ASD in boys. The psychologist who evaluated my dd knew this, specifically talked about it, and based her dx on the whole picture. The ADOS is only part of an ASD diagnosis.

I'm not discouraging you from looking at it, but just be aware that ASD could still be in the picture even if she would appear to "pass" the ADOS.

[PeterPan]

13 minutes ago, Jentrovert said:

Just keep in mind, girls present differently and it's a known thing that the ADOS does not properly evaluate girls. Questions and scoring are based on ASD in boys. The psychologist who evaluated my dd knew this, specifically talked about it, and based her dx on the whole picture. The ADOS is only part of an ASD diagnosis.

I'm not discouraging you from looking at it, but just be aware that ASD could still be in the picture even if she would appear to "pass" the ADOS.

Bingo. A psych who sees a lot of girl autism is going to diagnose in spite of the ADOS. And no, you can't see it because it's interactive, with modules. You don't WANT to know what's in it, because you don't want to do things that skew the results, which you would inadvertently do. Just live your lives, be normal, and get the evals for ASD done raw, natural.

8 hours ago, SKL said:

Re ASD - she didn't rule it out, but just didn't want to try to address both at the same time.  I can kind of understand that, especially if there is a good chance that the OCD can be brought under control enough to see what else is there.

That's what an MD does, dealing with one thing at a time. You could check with a good psychologist, but they should be able to tease them apart and identify all the components with their eval. We have tools that discriminate mental health and ASD. This is not an uncommon question and it's what psychologists do.

 

[PeterPan]

12 hours ago, katilac said:

Teaching strategies

Complete strategies with complete evals. Incomplete instruction with incomplete evals. The issue is not whether what they'll say is good, but whether it's complete. And my point is that starting somewhere, without complete evals or complete understanding of what is going on is basically a failure-driven approach, saying she gets more access to care and evals when it fails. And more fundamentally, it's telling her what the functions of the behaviors are (OCD vs. ASD) rather than helping her sort it out for herself. 

Just the fact that the op doesn't want to have the autism talk with her dd is kind of striking. It might be the talk to have. It might be PROTECTIVE, by saying you know, there are multiple explanations for repetitive behaviors. We're going to run this path, but there are other explanations. If you don't think this path makes sense, we're going to run more evals and get more complete explanations. 

https://rogersbh.org/about-us/newsroom/blog/asd-vs-ocd-symptoms-in-children  Notice in this article that basically they're saying the same thing could be either a stim or OCD. And to me, that's for the person themselves to sort out, what the function is for them. 

https://www.kelly-mahler.com/what-is-interoception/  Helpful article on interoception, which is at the root of self-awareness needed to implement cognitive strategies.

If the op's dc has never had an OT eval, that would be a really logical place to start. She has repeatedly brought up sensory and that's another thing this MD didn't bite on. My dd was 11/12 when she had her first OT evals. It was eye opening for her, because all kinds of things she had struggled with finally made sense. Good OT eval, interoception/self-awareness work, this can all feed into better ability to use cognitive strategies.

[Terabith]

Yeah, my kid has passed the ADOS at least twice, but everyone is pretty much in consensus that she has ASD.  It took till she was 11 before that was decided definitively, even though I took her for her first evaluation at 2.  She had multiple comprehensive evaluations, including with a neuropsychologist, where folks were like, “Yeah, it seems like she’s on the spectrum, but she passes the tests, so I guess not.”  It was a random psychologist she was seeing at 11 who was like, “This is nuts.  These are the criteria.  This is how she fits each of them.”  And everyone, kid included, was like oh yeah!  That makes SO much sense.  

[katilac]

1 hour ago, Terabith said:

She had multiple comprehensive evaluations, including with a neuropsychologist, where folks were like, “Yeah, it seems like she’s on the spectrum, but she passes the tests, so I guess not.”   

That's nuts! ADOS is not required for a dx, it's really depressing that there are experts who don't know that.