The need for a Comprehensive Assessment

I have often been asked what constitutes a full comprehensive diagnostic assessment.  I currently attend a National Specialist Interest Group for NHS Psychologists who work with and assess adults who have Autism Spectrum Conditions.  One of the common topics of discussion is what is the minimum requirement that constitutes sufficient for a clinician to be able to come to a diagnostic conclusion.  In the NHS of course it is more related to time factors, limitations of budgets and resources, waiting lists and how we can best serve the needs of people who come for assessment.  In private practice, one of the big concerns for potential clients is being able to gain a robust assessment, and a formally recognised diagnosis that can be used to not only better explain the person’s history, but also to enable them to be recognised for their differences.  And of course, to do this costing a reasonable amount of money and time.

So what is the minimum?

Well, the first thing I always recommend, and the NHS team I work for demand in almost all cases, is an initial brief screening assessment.  This enables a clinician to be able to tell whether the full assessment is warranted, and is almost always a helpful and enlightening process to go through.  In the NHS it is not possible to have the time to assess cases where a person just has a curiosity, but lacks enough ‘impairment’, causing their lives to be affected in a negative way.  There is more scope for this in private practice because the person is paying for this process and therefore may have more say.  I for one however, would not go ahead following a screening assessment, if I didn’t think the individual could possibly benefit from the process of assessment.

So the minimum is what is required in order to have a good degree of certainty, and that will have the most benefit for the person concerned.

I have to STRONGLY state that anyone who considers assessment, MUST find someone who uses industry recognised assessment packages and is sufficiently skilled and qualified to use them.

For Asperger’s Syndrome, I use the AAA, the Adult Asperger’s Assessment, created by Simon Baron-Cohen, Sally Wheelwright and colleagues (January 2006) as the first stage.  A developmental interview is also required, for this I use the Diagnostic Interview for Social and Communication Disorders (DISCO).  This was created by Dr Lorna Wing and Dr Judith Gould, also foremost pioneers and experts in the field of Autism.  I am also trained in the use of the ADOS, the Autism Diagnostic Observational Schedule.

With the combination of these assessments, that are in-depth and highly detailed, in addition to observations, a detailed history, sensory issues, and any other additional information, including school reports where available, a comprehensive picture emerges that either indicates a diagnosis is likely or not.  I have worked with people who have Autism for almost 20 years now, both those of typical intelligence, as well as those with intellectual impairment, and this experience is vital too.

There are of course other assessment packages that can be used, such as the ADI-R, the Autism Diagnostic Interview, and the ADOS, but again, it is the combination of these that provides sufficient information for clinicians to make a decision.

Yes, private assessments are not cheap, but this is because it takes a long time to be rigorous enough, to explore each individual’s life and history, to know whether criteria are met.  The process of assessment is powerful in other ways as well, and is often a journey of discovery for many.  Whilst the cost is prohibitive for some, the power of being able to confirm a diagnosis is rather hard to quantify.

I hope that makes things a little clearer for those who are interested!  I welcome any questions on this topic or anything related to this field.