Did my assessor not go deeply enough into my diagnosis?

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Hi all. I'm curious about how you guys were diagnosed. I've seen some people say that being diagnosed based on a test wasn't necessarily enough for a diagnosis and that it was more of an observation thing.

According to my assessor in the report, she said I was on topic successfully, made good eye contact (although this is questionable, as I do NOT like eye contact and never have.), I spoke normally, behaved normally and that I just appeared very anxious when I was answering questions. I've been told I am well spoken and well behaved, so maybe this is why? She wrote I was good with transitions between activities and was very compliant the entire assessment, I didn't go off on tangents about other things and I had a clear thought in mind when I was speaking.

We took an IQ test, the ASQ, and a bunch of other ones like a personality test and things regarding my empathy. My mom had to fill out some things for me since I was still a minor at the time. Most of the tests my mother filled out were asking about childhood experiences, any signs they noticed, and how I was socially and at home. I apparently scored eh on the one asking about my childhood. I think a 6 out of 15. My IQ results were too varied to be determined, something along the lines of that. I scored a 33 on the ASQ, which was apparently over the threshold. I'm not sure of the threshold to be diagnosed, though. I believe it's 26? Anyway, all I really got from the IQ thing was that I had a bit of a slow visual processing speed, poor memory recall, stuff like that. But I excelled with vocabulary and using words. I agreed with that entirely. I think she also associated those things with autism as well so that influenced her diagnosis?

I hear about everyone else doing something called the ADOS. I never went with that at all when I was assessed. I wasn't even getting specifically assessed for autism, either. I just went to a neuropsychologist that an old therapist recommended. I'm starting to feel like I was possibly assessed based on a bunch of questions, rather than actual behaviors. Masking is a thing, of course. I tend to mask without even realizing it and it can be hard to consciously stop myself when it's like an automatic "I need to do this and this." thing in my head. I'm thinking I could have possibly masked throughout the entire thing, but she could see something more. Eye contact, for example. I have to remind myself to make it. Or I have to remind myself that I need to restrain my stimming at times.

Apparently she was going to go with anxiety, but saw the social struggles and struggles to be more like others my age and keep up was ASD instead. I do have a great deal of anxiety, though. Not for everything, but I tend to get anxious about things I know will make me feel bad like loud noises and crowds. It's not always an ongoing anxiety, but it comes and goes and ebbs and flows as certain situations arise.

I'm really confused, because it seems like in this report I "behaved neurotypically", but yet she said she thought deeper and recognized ASD. She at least acknowledged how ASD can present in girls. She said it wasn't as noticeable a lot of the time for folks like me, and could be written off as just introversion, being a hermit, a homebody, socially anxious, shy, etc. I do, however resonate with the diagnosis. So I guess that could answer my own question with needing another assessment lol!

I would assume any psychologist would be aware of Autism but that doesn't mean it is one of their specializations. I specifically sought a psychologist who worked with Autism and who would do an Adult Autism Assessment. Observation was part of the evaluation process and ADOS was one of the tests used.

I'll admit there are parts of the evaluation that I don't know whether they were part of an accepted evaluation process or just something the psychologist did to see how I would react.

I'll also admit the evaluation was kind of fun. Parts of the evaluation process were clearly designed for children—the more usual subject of an Autism assessment. I see no reason to distrust the results from those parts of the evaluation but the psychologist seemed a little embarrassed about administering them. I was amused by them.

The gold standard for an ASD assessment is that ADOS: Autism Diagnostic OBSERVATION Scale. You are given tasks, and you are observed. I won't give more detail in case you decide to get re-assessed, and I don't want to reveal any spoilers. I was also given the SRS, which is also instrumental in assessment. My examiner also tossed in some sarcasm to see if I'd catch it. I didn't know this till I read the report. I took everything seriously, but there had been times she was kidding and I didn't know it. She set me up. This is what a good examiner does. Her only job is ASD assessments.

I asked right off the bat if good eye contact would disqualify me. She said not at all, but my eye contact WAS noted in the report; it was intense at times. She noted that I "struggled" with eye contact based on my subjective report of eye contact while I do a lot of listening in one-on-one situations: It feels mechanical and I'm aware of it, and it's a fixed stare. I also made sure she knew that I don't have meltdowns or shutdowns and never had a mask-induced burnout. I wanted the asessment to be as fair as possible. I got the diagnosis anyways. The ADOS revealed things that were very indicative of autism. Self-reports of stimming and special interests also played a role.

I was diagnosed about 7 years ago, so there might be differences now that I am not aware of, but I think I have some input that might be helpful for you.
It makes a difference whether the professional you see specializes in autism disorders, or at least has received specialized autism training or education. A general psychologist or psychiatrist or therapist or any "-ist" may not have the knowledge to be able to accurately observe and analyze your behavior. My psychologist was specialized in autism and her entire career was centered on autism, so she had a large base of education and experience with it. She didn't have me do any formal tests. We had a long conversation about a lot of things, she asked a lot of questions and we discussed many topics that didn't seem at the time to be relevant. At the end of the conversation, she said she believed I was autistic based on her observations, and she gave me a lot of details that I didn't really listen to, so I don't remember them.

But the important point is this: If you're happy with your diagnosis, there's no reason to seek a second opinion. It sounds like the therapist concluded you are on the autism spectrum. If you are OK with that, let that be good enough. It isn't necessary to get a "better" diagnosis. It won't help you believe it more or convince other people more or get more services.

If you aren't happy with your diagnosis, try to find another professional who has specific autism training and experience and get another analysis done by them.

You may not have missed much: I was subthreshold on the "gold standard" ADOS, as are 30% of adult women (according to one study). By the ADOS2, I do not have ASD, but the dr diagnosed me with ASD based on a multitude of other factors and I am in agreement. Like you I am very good at masking, although I tried not to for my evaluation, but it was still so new to me that mostly I did. So for me it was also being "too" well behaved. On the other hand, my daughter's assessor went with the "introverted" theory so gave her "Expressive Language Disorder" instead of ASD. I will seek a reevaluation for her in due time. In the meantime she's been fortunate to receive support in any case.

Wishing you well as you "digest" this. I'm three years out from my diagnosis and so glad for it!! ! I'm learning to assert myself and recognize and articulate my needs. I still struggle with shame, but am improving. Good luck!

The heck with shame. I'm still assessing how glad I should be.