When imagining a Diagnostic Assessment, many of us think of what we’ve seen on television. There’s someone in a lab coat who is rattling off questions and everyone sits in a quiet room on an uncomfortable couch. That can’t be further from the experience of a child at ACP.
If you feel it would be best to seek an assessment, your Psychologist will often be engaging and playing with your child while observing their reaction to prompts like toys. They’ll also ask you and maybe your professional team, like a daycare provider or pediatrician, to complete questionnaires on your child’s typical behavior. All of these things influence the interpretation of your child’s potential clinical presentation. To your child, it just looks like a day where they play with a new person.
The process of considering and seeking an evaluation can be intimidating for caregivers. Am I making the right choice? Especially when you factor in recent rhetoric about how terrible an Autism diagnosis is and how it’s a caregiver’s fault if their child is neurodivergent. ACP does not support these claims. We know Autism is not a disease, is not something that needs to be cured or hidden, and isn’t caused by factors like Tylenol consumption.
When thinking about preschool or kindergarten, there are so many factors to consider for any child, but potentially moreso for a child with an Autism diagnosis or similar challenges. In this article, we met with Dr. KP Patrick to better understand his perspective on the diagnostic process, what a diagnosis means for families, and how a diagnosis might impact school readiness. We hope this article helps guide you and calms your heart. When you’re done reading, give us a call or send us an email so we can help answer your additional questions!
Tell us about yourself.
This is always the hardest one. So, I’m KP. I use he or they pronouns. I am a Clinical Psychologist here at Autism Care Partners, and I also have a private practice where I see clients for therapy. I’m a husband and a parent to two pretty wild children. I’m happy to be here.
You support very young children. How does that influence your assessment strategies?
I would say flexibility is my superpower when it comes to little kids. I think in a lot of other places and spaces, assessments are very clinical, and they can feel very rigid because there are rules that we have to follow. There are protocols we have to follow. But it doesn’t make sense if you can’t connect with the kid and the family. I don’t do things only the traditional way.
I like to be on the floor rolling around with the kids as much as my knees and joints don’t really appreciate all of that. [Smiles] I really try to get on their level, both physically and emotionally and mentally. I think that influences how I approach the assessments.
I try to meet families where they’re at. They’re usually at a really anxious spot. They have sometimes some preconceived notions about what’s happening. Sometimes some anxiety. I try to explain to them what I’m doing, because they’re looking at me playing with their little kid and don’t really understand what’s happening. I like to make sure that both the kid understands and is comfortable and the parent understands and is comfortable with what’s happening in the room.
It’s got to be flexible. The assessment speaks to—aside from the diagnosis, which is important—the strengths and weaknesses. If we really break it down into its parts, we can see for example maybe they’re not making eye contact, but they are really trying to show and share with you and things like that.
How does receiving a diagnosis at such a young age change things moreso than a diagnosis later in life?
I think both can be really impactful and both can have their time and place.
I think when you’re getting a diagnosis when you’re young, it adds more time for understanding and for services and support. I also think we often forget that younger kids are shaping their world at that age. We’re shaping our understanding of ourselves, we’re shaping our core beliefs, and we’re shaping an understanding of who everybody else is in relation to us.
And so, having a diagnosis at a young age allows the caregivers and the adults in that child’s life to shape a world that fits that diagnosis.
Whereas when you get a diagnosis later in life—there’s nothing wrong with that—but you are then contending with the world that has already been shaped for you without the diagnosis as context.
So, I think it’s really helpful when they’re younger, especially for the parents and the caregivers to understand, Okay, this is why my child needs this. This is why my child’s reacting in this way, and we can help them understand it’s not because you’re weird or you’re crazy or anything like that. But, because your neurobiology is working in this way. And that’s okay.
I think a lot of the parenting advice or how we learn how to parent comes from social media and how we were parented and friends and things like that without remembering, that kid that’s just your kid, Autism or not. We all have to shift our stuff to accommodate for our kids. I think particularly with someone who is Autistic, really understanding these are the strategies that work for them. And these are the ones that don’t.
Many families are being inundated with school information at this time. Many of those caregivers are weighing the pros and cons of their child starting preschool or kindergarten. What might tell a person that their child is ready for preschool or if they would maybe benefit from an intervention instead of or in addition to that preschool?
This is a tough one, and it is very case-by-case basis. It depends on the kiddo and what the ultimate goal is. If the goal is for the kid to be able to be in a classroom, remain regulated, soak up the information, then I think there’s different ways we would approach that. I would think of it on a scale almost.
Maybe on the lower end of the scale, you have a kid who might not right now be able to function well in the classroom or absorb that classroom information. If we then push that kid into being in a preschool or a kindergarten, they’re going to be deeply impacted by that experience, because they’re not actually going to gain the learning. They’re going to be super dysregulated.
Those are the kids I would recommend for intervention only. So, I would delay in that case.
Then you probably have the kids in the middle that might be able to function or absorb what’s happening in the classroom, but still they’re using all their executive functioning skills during the day. So, they’re just like pooped at the end of the day.
What is executive functioning?
So executive functioning, in my understanding, is our brains ability to manage things like tasks, time, and emotional regulation. Essentially, it’s the part of our brains that keeps us calm and able to follow through with things we need to do. When kids, in particular, are struggling with executive functioning, we see an increase in maladaptive behaviors, like tantrums, difficultly with task initiation, etc. Disorders like ADHD and ASD significantly negatively impact executive functioning skills.
As adults, with fully formed frontal lobes, we can see this as defiance or oppositional behavior. When really it’s a child—without a fully formed frontal lobe—who is neurodivergent and experiencing the world in a very different light.
When we experience a big feeling, our executive functioning skills kind of go offline. This is true for adults and kids alike. We get more into needing immediate rewards and what not and stop thinking through things as much. Imagine being Autistic where everything can feel like a big feeling. You’re in that raw state nearly constantly!
I think sometimes viewing it from that standpoint can change the game for parents. Essentially, the kid is not trying to be a “problem”, they just need a bit more hand holding and skill building to develop their executive functioning skill.
So, for those kids in the middle of the spectrum we were talking about, I might recommend starting with an intervention and then we’ll use school as like a practice in real time for all the skills that they’re learning.
We’ll start with like, how do we sit with calm bodies and calm hands? How do we engage socially? Things like that. Then when you go to the classroom, again, you can practice that outside of the intervention room.
I’d say at the top of that scale, there’s maybe the kids who can function and absorb the information in the classroom. And those are the kids I’d say might be ready for school with some in-school supports.
So, making sure they have a connection to the school counselor or making sure they’ve got their calm corner or things like that.
Really, going back to being case-by-case, that’s a conversation to have with parents and the clinician who knows the kid in the school. Let’s all put our brains together and what we know about this kiddo and figure out what might they need right now.
I think there’s no hard and fast rule.
Some caregivers might be fearful of seeking a diagnosis because of stigmatizing rhetoric. What would you say to those individuals?
I would say—and I frequently do say in my feedback—if symptoms meet criteria, diagnosis is context. Your kid was the same kid that they were 5 minutes before you found out they have Autism. That’s not going to change.
It just is a helpful understanding of what they need in this world. I think there’s a couple of things.
One, yes, if people are going to look at your child differently, those are not your people. Those are not the people that are going to be around your kid in a helpful way anyway. Because again, diagnosis on paper or not, your child was already displaying these things. So, if you’re not surrounded by people who are going to understand that and want to work with that kid, they’re probably not the support you need in your life.
I think also understanding is probably one of the most important goals we can have in our life, like self-understanding. If we can have a deep understanding of who we are as a human being, that’s a gift I’d give to my kid over anyone else’s observations. I don’t want to deny there is stigma and people are going to say things or give looks or what have you.
I’m looking just at my child, and I want them to know who they are, be proud of who they are, work with who they are … That has to take top tier priority for me at least.
Does starting a therapy service instead of preschool or kindergarten or a combination of therapy and school negatively impact the success of a child?
I’m super biased here, but I would say again it’s case-by-case, but overall, no. Working with the providers again to set realistic goals—if getting them into kindergarten is a goal—then I would say the only way I think it could be negatively impactful is if the provider and the parents are not on the same page in terms of what we’re working towards.
But more support for your kid, I can’t imagine being a negative thing.
Is there anything additional that we should know regarding diagnostic assessment?
I think the one thing that I think often gets missed with some of these conversations or really in the context of assessment in general is cultural context. It’s a huge part of my work. It’s important to remember that. I don’t—nor do any of these families—live in a bubble.
Diagnosis is important. Assessment is absolutely important. But if we are ignoring things like race, gender identity, socioeconomic status, family makeup, all these other things, we’re missing that kid.
Remembering the goal here is to see that kid and to see that family, the diagnosis is a part of that, but it’s really, really important to see all the other pieces of that kid and all the other factors.
I personally find it really impactful in the work and the reports that I do, especially because it can be a barrier to seeking services and good information. I want to be realistic with these families. What’s both optimal and what is what you have access to? Because those two can be two different lists. How we bridge the gap as much as possible?
You’re a parent yourself. How has that experience influenced your work?
It’s changed absolutely everything. I think from my work to my personal to my internal life. Being a parent has changed the game on everything. I’m definitely more tired, so that definitely impacts me. [Smiles] But, I think one of the biggest pieces is it has made me understand what is both realistic and probable for parents to do rather than kind of advising them from a high horse. I think sometimes, particularly pre being a parent, I would say, Oh, well, this is a strategy … just throwing strategies out at parents.
Now as a parent myself, I think I have a lot more grace for parents and the exhaustion that comes with it and the stress and the anxiety that we were talking about earlier.
I’m able, I think, to translate some of those strategies a little bit more to saying like, Well, it’s not perfect. Doesn’t need to be perfect. That’s not the expectation. Let’s make a coping strategy that works for all parties involved, because otherwise it’s kind of useless.
As you think about the approaching school year, ACP is here to support you. If you have a center team with ACP, talk to your support system about your child’s progress and readiness for school. They might be able to help support you through the process of creating an IEP. They might also have guidance for considering if your child is ready for school if they have communication or motor challenges.
If you’d like to learn more about Diagnostic Assessment with ACP, read more about our process, and meet the team by exploring our website further. We’re here to support you and your child! You can reach us at 800-679-3609 or email us at Welcome@AutismCarePartners.com today!
