Autism Spectrum Disorder: Can Psychologists Diagnose?

What is autism?

According to the American Psychological Association, Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that affects behavior, communication and social functioning. The term “spectrum” means that ASD symptoms exist on what is called a continuum. It can present differently across gender and from person to person.

Some people with the disorder who may be considered higher functioning are able to have a traditional schooling experience without issue, maintain jobs, and perform their functions of daily living mostly or totally independently. Others have significant impairments (including intellectual) and need more extensive support and assistance throughout life. These tend to be the two ends of the spectrum, and a variety of experiences exist between these two.

What are the symptoms of Autism?

Autism symptoms can vary from person to person and across gender. But some of the quintessential signs of autism that many people on the spectrum possess (from early childhood to young people) are:

• Challenges with Social Interaction: Children with autism often struggle with social skills and with understanding social cues. They may find it challenging to do things that neurotypical do with ease such as making eye contact, engaging in conversation where there’s a natural volley of speaking and listening, or understanding social norms.
• Difficulties with Communication: their speech development may be delayed, they may have difficulty expressing needs and emotions, they may use repetitive language patterns, and engage in something called echolalia, which is the repetition of words or phrases.
• Repetitive Behaviors and Interests: they may engage in repetitive movements (like hand flapping, rocking back and forth), fixating on specific topics or objects, and stick to rigid routines without much flexibility.
• Sensory Sensitivities: many autism people have sensory sensitivities to thingslike sounds, lights, textures, or smells.

What does a diagnosis include?

To start, the person being assessed must meet what’s called criteria for the diagnosis, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is a reference book on mental health and brain-related conditions and disorders. To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction, plus at least two of four types of restricted, repetitive behaviors:

• Persistent deficits in social communication and social interaction across multiple contexts
• Restricted, repetitive patterns of behavior, interests, or activities
• Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
• Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
• These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay

As far as the diagnostic process is concerned, it tends to vary from practitioner to practitioner. But a diagnostic assessment will likely include:

• Monitoring
• Screening/assessment
• Diagnosis

There are a variety of individuals who can see to get a diagnosis of autism. According to the American Psychological Association, psychologists, pediatricians and neurologists (with relevant experience and areas of expertise) are all qualified. This qualification can also include school psychologists, clinical psychologists, and child psychologists.

To make a formal diagnosis of ASD, psychologists draw on a number of sources of information as part of the assessment process including:

• Observations of the person’s behavior
• Tests of cognitive and language abilities
• Medical tests to rule out other conditions (which can be done through healthcare provider medical documentation provided by a family member if the examining professional is not qualified to conduct a medical test; this may also include a medical history)
• Interviews with parents, teachers or other adults who can answer questions about the patient’s social, emotional and behavioral development.

A pediatrician’s autism assessment usually looks a little different because that person is a medical doctor who specializes in the treatment of children, not the diagnosis and the treatment of disorders of thinking, feeling, and/or behavior. In many situations, medical doctors use a checklist or screening tool to diagnose autism or refer a child for a diagnosis. The checklist typically requires the parent/caregiver to complete a questionnaire regarding the child’s development and behavior. There may also be a brief interview. If the pediatrician is not confident in diagnosing but suspects that the presence of autism is probable, they may refer the parent and child to a specialist. However, if the pediatrician is a developmental pediatrician, they may feel comfortable making the diagnosis themselves. For particularly skilled pediatricians, concerns regarding the possibility of autism may be caught in a developmental screening during a routine checkup.

Psychiatrists (medical doctors who specialize in the treatment of children, not the diagnosis and the treatment of disorders of thinking, feeling, and/or behavior) may diagnose autism using psychological evaluations.

Medical diagnosis versus educational diagnosis

A medical diagnosis is a diagnosis provided by a medical doctor or medical professional. In many states, there is also something called an educational diagnosis, which is provided by school psychologists like me. The criteria to meet an educational diagnosis of autism can vary across states and even across school districts. However, the one thing that is constant is that in order to receive an educational diagnosis of Autism, the symptoms and characteristics of autism must be present and the symptoms and characteristics must impact the child’s educational performance. This can be a learning impact, a behavioral impact, a social impact, or any combination of the three.

Should I seek a medical diagnosis or an educational diagnosis?

The vast majority of my experience working in education has been with neurodivergent individuals, specifically those with autism. As a school psychologist, I have had many conversations with parents and families about autism diagnoses and the importance of understanding what they mean so that they can make the right choices for their children and families. My recommendation is typically for a family to have the evaluation done through a psychologist (and when they choose me, it’s typically done through the local school district). If the child meets criteria, I can provide an educational diagnosis and start the process of providing accommodations, modifications, and/or specialized instruction at school. The family can then take that evaluation report to the child’s medical doctor and get a medical diagnosis. With that angle, they can get certain intervention services (which is particularly important for early intervention), possibly a treatment plan, and reimbursement through insurance.

This allows for the most robust multidisciplinary approach and offers the most options for the child and the family.

So, yes, psychologists can diagnose autism. Ultimately, who you seek out when looking to rule in our rule out autism is up to you. Whatever you choose, remember that it’s essential that you see a qualified provider to get a formal diagnosis as well as an accurate diagnosis.

With both routes, other professionals whose expertise is warranted, given the situation, may be asked to participate in the treatment process and provide additional services. Examples of some of these professionals include speech pathologists, occupational therapists, pediatric neurologists, social workers, child psychiatrists, other medical professionals, and other mental health professionals.

TL;DR: How to get a professional diagnosis for ASD

In conclusion, as the prevalence of Autism Spectrum Disorder (ASD) continues to rise, understanding the diagnosis process becomes crucial. This blog aimed to demystify the confusion surrounding who can diagnose autism, emphasizing the pivotal role psychologists play in this process. ASD, a complex neurodevelopmental disorder, manifests differently across individuals, creating a spectrum of experiences.

The symptoms, ranging from challenges in social interaction and communication to repetitive behaviors and sensory sensitivities, necessitate a comprehensive diagnostic approach. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides criteria for ASD diagnosis, requiring persistent deficits in social communication and interaction, along with restricted, repetitive behaviors.

The diagnostic process, though varying among practitioners, commonly involves monitoring, screening/assessment, and formal diagnosis. Psychologists, pediatricians, and neurologists, with relevant expertise, are qualified to diagnose autism. The distinction between medical and educational diagnoses adds complexity, with educational diagnoses focusing on the impact on educational performance.

The recommendation or best practice guidelines, particularly from a school psychologist’s perspective, is often to undergo the evaluation through a psychologist. This approach allows for an educational diagnosis, enabling the initiation of accommodations and modifications at school. Subsequently, the family can seek a medical diagnosis, ensuring access to intervention services and reimbursement through insurance.

In essence, psychologists can diagnose autism, providing a multidisciplinary approach that involves various professionals to cater to the individual’s needs comprehensively. The key takeaway is the importance of consulting qualified providers for both formal and accurate diagnoses, empowering individuals and families with informed choices for intervention and support.