PP here, yes of course. I wasn't meaning that was the definitive thing. Just typing quickly and trying to respond to that portion of OP's post. Good point though. It's complicated!

Anonymous wrote:I'm a therapist and I worked with an older teen client who had also had a lot of expensive testing (but no ADOS). After some time I suspected that he had HFA but the signs were subtle and it took me several months of seeing him before I felt I had enough information to talk to the parents. When they investigated further and did some additional tests, he was diagnosed. They had also always suspected it so I don't know why the very prestigious place that did the testing didn't at least do an ADOS to rule it out. When I talked to the testing psych, she said she met with him for a morning and based on eye contact didn't feel like he needed an ADOS. Huh? Follow your gut OP and find someone to do some additional testing.

Well, ADOS does not rule out or rule in autism on its own. You need a fuller clinical picture.

I'm a therapist and I worked with an older teen client who had also had a lot of expensive testing (but no ADOS). After some time I suspected that he had HFA but the signs were subtle and it took me several months of seeing him before I felt I had enough information to talk to the parents. When they investigated further and did some additional tests, he was diagnosed. They had also always suspected it so I don't know why the very prestigious place that did the testing didn't at least do an ADOS to rule it out. When I talked to the testing psych, she said she met with him for a morning and based on eye contact didn't feel like he needed an ADOS. Huh? Follow your gut OP and find someone to do some additional testing.

This is OP ...
We are planning to transition to public school next year. I guess I'm hoping if there is an ASD diagnosis it will help teachers and administrators see him and some of his rigidity in that light instead of as a willful behavior and maybe help them work with him a ltitle better. I don't know that it would change much otherwise.

Anonymous wrote:In theory the ADOS is supposed to be reliable, so there should not be a huge discrepancy. But it sounds like clinically only one professional sees signs of autism. I do think that's an important piece of information.

Well it's the therapist who sees him regularly rather than the clinician who tested him for a few day. We all know kids can present differently in different settings.

I would follow your gut, op. Your gut was telling you to have the ADOS administered. Personally I think information is useful. I feel bad for kids whose parents put off or refuse testing b/c they are trying to avoid certain diagnoses. I'm glad your kid has you in his corner, op.

In theory the ADOS is supposed to be reliable, so there should not be a huge discrepancy. But it sounds like clinically only one professional sees signs of autism. I do think that's an important piece of information.

Anonymous wrote:DS is 8yo and has seen a dev Ped (at 6yo) and had a neuro psych last year that identified ADHD and LD. They did not do an ADOS in spite of my concerns and assured me DS is not on the spectrum. Now DS is seeing a psychologist for therapy. She strongly suspects HFA and is suggesting an evaluation at Children's National. I have always suspected something else besides "just" ADHD, but how likely is it really that multiple professi I nails -- dev ped, psychiatrists, and psychologists -- have missed it in past evaluations. And if he does end up with a diagnosis, does it actually really change anything?

I think that for some parents and children having a diagnosis provides gives them a prism from which to view how the child thinks and behaves. I know some parents who say they were relieved to finally get the diagnosis. If you do an evaluation with the autism specialists at Children's they will do a full neuropsych exam that would also be able to pick up that "something else" even if it isn't autism.

Anonymous wrote:DS is 8yo and has seen a dev Ped (at 6yo) and had a neuro psych last year that identified ADHD and LD. They did not do an ADOS in spite of my concerns and assured me DS is not on the spectrum. Now DS is seeing a psychologist for therapy. She strongly suspects HFA and is suggesting an evaluation at Children's National. I have always suspected something else besides "just" ADHD, but how likely is it really that multiple professi I nails -- dev ped, psychiatrists, and psychologists -- have missed it in past evaluations. And if he does end up with a diagnosis, does it actually really change anything?

The initial evaluation probably should have included an ADOS.

However, kids with ADHD and autism as well as a host of other LDs share a lot in common. People may not want to think so, but it's true.

It may not change much in the day to day, OP, but like other people have said, definitely make sure to get the help your kid needs. That may require getting testing to show that he's on the spectrum. Do you need more information on your kid? Do you feel like there are deficits that aren't being met, then go ahead and do additional testing.

Amen. These are all just poor attempts to impose arbitrary order and labels on a complex reality we do not yet fully understand. My friends with kids with "just" an adhd diagnosis invariably report some issues that I associate with the spectrum in my kid with a dual hfa/adhd diagnosis. There is no bright line, and for hfa kids the more important challenge can be the adhd. So whether or not your kid scores enough for an official diagnosis they can have some spectrum traits (eg, rigid black & white thinking) and understanding them can be helpful. My wife and I now see all of our own HFA tendencies more clearly even though neither of us would remotely qualify for a diagnosis. And we have had first class professionals say our kid does and does not fall on the ASD side of the "line."

Autism can present in many different ways so it's quite possible for the professionals to miss something especially since they are only seeing your child for a few minutes at a time. Although the diagnosis doesn't change treatment, it's a lot easier to tell future therapists that your kid is or is not on the spectrum, than to run through a bunch of uncertainties.

Anonymous wrote:What do you think? Its a checklist and very subjective. We have multiple diagnosis, all different from each provider.

+1 it's behavioral science not a strep test. Lots of shades of gray. At the end of the day, the important thing is to treat the challenges your child has, irrespective of how he/she is labeled (although an HFA label may make you eligible for more services.)

What do you think? Its a checklist and very subjective. We have multiple diagnosis, all different from each provider.

Sorry for stupid phone autocorrects.

DS is 8yo and has seen a dev Ped (at 6yo) and had a neuro psych last year that identified ADHD and LD. They did not do an ADOS in spite of my concerns and assured me DS is not on the spectrum. Now DS is seeing a psychologist for therapy. She strongly suspects HFA and is suggesting an evaluation at Children's National. I have always suspected something else besides "just" ADHD, but how likely is it really that multiple professi I nails -- dev ped, psychiatrists, and psychologists -- have missed it in past evaluations. And if he does end up with a diagnosis, does it actually really change anything?