About Diagnostic Evaluations - Questions and Common Misconceptions

What is the difference between the diagnostic evaluations you offer and psychological testing, or a full psychological evaluation?

A psychological evaluation is typically an extensive process - it is a time and sometimes cost intensive process of assessing cognitive, emotional, social and behavioral functioning.   Psychological evaluation can encompass many types of information gathering including many types of psychological testing (sometimes called a battery of testing) and is conducted by a Licensed Clinical Psychologist.  This type of assessment can be helpful for looking at a wide range of potential explanations for behavioral, social, emotional and neuro-differences, and is often valuable in evaluating developmental and neuro-cognitive differences, including evaluation for educational needs such as specific learning differences and disabilities.

My process is different in a couple of key ways: 

For one thing, I am a Licensed Clinical Social Worker - or LCSW - not a Licensed Clinical Psychologist.  This means there are key differences in my educational background and foundational training - though each individual in every field has areas of focus, specialization and training that may vary from others in their field - and there are slightly different core values, or guiding principles for my profession.  Licensed Clinical Social Workers do not conduct psychological testing, however, in Virginia, licensed clinical providers including LCSWs are ethically and legally qualified to utilize the current Diagnostic and Statistical Manual of Mental Disorders(DSM-5) in the process of diagnosis of ADHD and/or Autism. 

This means that while my process of assessment will include many forms of information gathering - social and developmental history, self-report inventories/questionnaires, and interview session(s) using neurodiversity affirming, evidence based diagnostic protocol - it does not include neuropsychological testing. 

My evaluations are intentionally limited in their scope, as this is my area of specialization and expertise - Diagnostic Evaluations for Autism and/or ADHD are for the sole purpose of evaluating and identifying/diagnosing Autism and/or ADHD.  Additionally, while I have extensive training and experience working with folks with complex trauma and mental health disorders, it is important to note that my diagnostic evaluation process does not seek to validate, nor reevaluate any previous mental health diagnosis, as the scope of my assessment process is limited to the identification/diagnosis of Autism and/or ADHD.

This means that I use my experience and training in assessment, trauma-informed practice and mental health disorders to consider a wide range of explanations for sensory, social, emotional, and behavioral differences for the purpose of clarifying ADHD and/or Autism using a neurodiversity affirming framework.  

But without a full psychological evaluation and psychological testing, is the identification/diagnosis valid?

In short, yes!  Licensed Clinical Social Workers(LCSWs) with supervised training and experience in clinical evaluation and assessment are qualified and capable of identifying/diagnosing Autism and/or ADHD in Virginia.  Commonly, LCSWs specialize and focus their clinical work on providing outpatient therapy services, and do not provide evaluation or assessment outside of an on-going client-therapist relationship. 

My history of clinical experience, training and current practice are a little bit different - in addition to experience providing individual, group, and family psychotherapy services, I have over 9 years of experience providing autism and mental health assessment, the past 3 of these years in my private practice developing my current process of assessment. Currently, one of my main areas of specialization is in the assessment of Autism and ADHD using a gender inclusive, neurodiversity affirming framework, and this work has been about 80% of my practice. 

In particular, my focus is in providing services that are inclusive of intersectional identities of gender, race and ethnicity and experiences with Autism and ADHD.  This is because for many of these folks, a lack of comprehensive training for licensed professionals about characteristics of Autism and ADHD, particularly as experienced by People of Global Majority (PGM)/Black, Indigenous, People of Color (BIPOC) and Women, Girls, Queer, Transgender, Non-binary and Gender Non-Conforming folks, can lead to missed diagnosis and misdiagnosis.  

I also use my time and resources to provide education, training, and support to other licensed clinical providers to build assessment skills, with priority given to autistic and/or multiply neurodivergent clinicians, as well as those who experience systemic barriers in the helping professions including BIPOC/PGM, LGBTQIA+, and/or disabled clinicians.

But I’ve been told that only a psychologist can diagnose Autism and/or ADHD?!

It is a common misconception that Autism and/or ADHD identification/diagnosis must be made by a psychologist, and must utilize psychological testing.  Licensed Clinical Social Workers, and other licensed professionals with appropriate assessment training are legally and ethically able to identify/diagnose Autism and/or ADHD in Virginia.   Psychological testing as conducted by a Licensed Clinical Psychologist can be very valuable in identifying co-occurring conditions when they are suspected - there are Autistic folks of all ages who have co-occurring mental health disorders, cognitive differences, language differences and learning disabilities and knowledge is power, always!   And also, full psychological testing and discrete measurement of functioning is not always necessary or relevant for folks seeking identification/diagnosis of Autism and/or ADHD.

Some, but not all, ADHDers and Autistic people do have co-occurring mental health and educational disorders - neurodivergent people often experience co-occurring challenges that may be understood as the result of numerous and interacting bio-psycho-social-spiritual factors, one of which may be the experience of being neurodivergent in a neurotypical world.  One of the many ways that a specialized Autism and/or ADHD evaluation can be helpful is by providing key information and understanding about innate neuro-differences and their relationship to on-going biological, psychological, social and/or spiritual needs to help physical and mental health service providers, educators, parents, caregivers and partners to foster self-acceptance, authenticity and accessible supports for neurodivergent people.

What do you mean when you say “trauma-aware, autistic-informed assessment?”

The Properties of Light intentionally centers the experiences of autistic people, including in my process of assessment, and is informed by experts of experience (autistic and neurodivergent people) in addition to my educational and clinical training. This means that I may utilize different tools for assessing and evaluating Autism and/or ADHD than other providers.  There are many evidence based measures for exploring characteristics of both Autism and ADHD - many of which are utilized by a wide range of professionals - but there are no specific, definitive psychological tests that are required to identify/diagnose Autism or ADHD.  

Additionally, I’m of the belief that assessment should not be a process that is pathologizing, othering, or otherwise harmful to experience. Many of the screening and assessment tools that are commonly used by professionals of many disciplines are rooted in behaviorism, pathology and deficits, and do not provide opportunities to respectfully explore and affirm the internal experiences of neurodivergent people of all genders, races and ethnicities.  My process of evaluation utilizes assessment tools within my scope of practice as an LCSW that are intentionally selected for their neurodiversity affirming, non-pathologizing approach to understanding, assessing and describing Autism and/or ADHD.     

If after facilitating the diagnostic evaluation it is my clinical opinion that the sensory, social, emotional, behavioral and neuro-differences described are better explained by a specific mental health disorder, I will share my recommendations for next steps for understanding and support.

If in my process of evaluation for ADHD and/or Autism, there is information that suggests that a co-occurring disorder or disability may be present in addition to characteristics of Autism and/or ADHD, I will share specific recommendations for further evaluation and/or testing as appropriate to identify co-occurring disorders and potential supports.  Often these recommendations have included evaluations for sensory processing, motor skill development, auditory processing, speech and language disorders, learning disabilities, or mental health disorder, and include referral to a wide range of professionals including occupational therapists, speech language pathologists, audiologists, educational psychologists, mental health therapists, and psychiatric nurse practitioners.