It’s a good question. And I’ve written this blog post because it’s one I get asked a lot. There are so many thoughts I’d like to share! Women often ask whether they’ll be assessed by a speech and language therapist, a clinical psychologist, or another professional in our team. Professional training and experience are important, but there’s so much more to think about. As Clinical Lead at Autistic Women, I consider many different factors to ensure the best possible ‘pairing’ between clients and clinicians. Just call me Cilla of Autistic Women! Learn about our AuDHD assesment for women.

Why is the pairing process important?

It’s often a hidden part of a clients’ autism and/or ADHD assessment process, but it’s essential.

Most services pay no attention to the pairing and simply allocate a client to the next available clinician. And for many reasons, a clinician may not be the right person for a client. This can lead to an unsatisfactory assessment experience (for client and clinician), possible overdiagnosis, or more likely, missed diagnosis(es).

Alternatively, a well-considered pairing can:

• Help clients feel truly heard and understood.
• Reduce clinician burnout by assessing clients that ‘fit’ them.
• Allow both clinician and client to be in their flow.
• Ensure an accurate assessment and diagnosis.

The role of initial screening asssessments

Why are initial screening assessments so important? They involve gathering information about a client. Whilst this helps to decide whether a full assessment is currently an appropriate next step, it’s also an important part of how we match clients and clinicians.

Creating a multi-disciplinary team

From initial screening to a full assessment, we ensure women are assessed by at least two, and often three, clinicians. We choose clinicians from different professional backgrounds, so we genuinely create a ‘multi-disciplinary’ team.

This makes sure we’re confident in the diagnosis(es) and that clients trust our process. And where needed, it also means we can offer different perspectives on a person’s support needs as they move forwards.

So, what factors do we consider?

1. Professional training

A variety of trained clinicians can assess people for autism and/or ADHD.

NICE guidelines for adult autism assessments advise that clinicians should:

• Be “professionals who are trained and competent.”
• Ensure assessments include “core autism features,” developmental history, physical and mental health, “other neurodevelopmental conditions,” and sensory sensitivities.
• Be able to carry out differential diagnosis. This means exploring whether a person’s experiences are best explained by autism, something else, or a combination of experiences.
• Check for areas such as mental health, physical issues, and communication difficulties separate to autism.
• Assess for potential self-harm, neglect, exploitation, and abuse.

NICE guidelines for ADHD assessments highlight:

• “ADHD should only be diagnosed by a specialist psychiatrist” or another “appropriately qualified healthcare professional with training and expertise in diagnosing ADHD.”
• This must be based on a full clinical assessment, “a full developmental and psychiatric history,” and observations of the “person’s mental state.”

Certain clinicians have the basic training to meet the requirements of assessment guidelines. For example, speech and language therapists, occupational therapists, psychiatrists, nurses, and practitioner psychologists (including clinical, counselling, and forensic).

However, after they qualify, clinicians must also have specialist training and supervised experience in assessing autism and/or ADHD. This shows they are not only trained, but also competent.

Alongside these guidelines, I also consider a client’s lived experiences. For example:

• If a client has experienced trauma, I usually think a psychologist is best to assess. A psychologist can help to differentiate between the impact of trauma on the nervous system and/or social communication, and an autistic and/or ADHD nervous system.
• Where a client has communication differences and/or is semi-speaking, I would usually pair them with a speech and language therapist.

Links to NICE guidelines

NICE Guidelines: Autism spectrum disorder in adults: diagnosis and management

NICE Guidelines: Attention deficit hyperactivity disorder: diagnosis and management

2. Professional experience and areas of expertise

A clinician’s experience is just as important as training and qualifications. This might be their experience within working roles, any specialist training, and professional interests.

There can be speech and language therapists who have gained more experience and knowledge from working in mental health services than a clinical psychologist.

Likewise, there might be a clinical psychologist who has worked more within specialist autism teams and with people with speech and communication differences than a speech and language therapist.

Our team has a wealth of professional experience in different areas. This includes dyslexia; eating disorders; PDA; childhood abuse and trauma; self-harm and suicidal ideation; neuropsychology and brain injury; mental health diagnoses such as OCD, depression, and ‘personality disorders’ including EUPD; the intersection of neurodivergence with gender, including transgender; sexuality; culture; race; menstrual cycles; menopause; and more!

3. Personal/ lived experience

This is possibly one of the most important factors! A clinician is more likely to truly ‘get’ the autistic and/or ADHD experience if they are autistic and/or ADHD themselves. Similarly, if they live with neurodivergent family members and/or have close friends who are neurodivergent.

Of course, this isn’t always the case. Someone can be autistic and/or ADHD but not have consciously explored who they are and what that means to them.

At Autistic Women, all our clinicians are either neurodivergent or have close family, friends, and/or colleagues who are. We create an assessment space where girls and women can be seen and understood. If being a parent is a crucial factor, a client might be matched with a clinician who is also a parent.

You’re guaranteed to be paired with a clinician who ‘gets it.’ It’s possible for a clinician who isn’t autistic and/or ADHD to create this space, but it is much more likely and easy for someone who is.

Clients can receive reflections from a clinician’s lived experiences. Even without explicit discussion about lived experience, there can be a knowing between people. There might be a connection around communication and interaction preferences, experiences of passions and interests, or from how they find their attention is dynamic and moves around freely.

Personal/ lived experience factors are not always essential, but sometimes they are. So, we take it one step further by matching up lived experience with training, qualifications, and professional interests. This helps create something unique, safe, and effective, leading to a meaningful diagnostic assessment.

4. Personality factors

Knowing what would help a client and clinician ‘click’ isn’t an exact science. We can start getting to know a client through a screening assessment, but there will still be a lot we have yet to learn and understand.

However, we know our team very well. And as Clinical Lead, I’m experienced in understanding groups, families, and pairs. I understand the personality factors that are most likely to complement each other in an assessment. For example:

• Some clients need lots of processing time. They might be well matched with someone who naturally adapts to a gentler paced assessment.
• Other clients might prefer things at a faster pace and be suited to a clinician who also has a quick-thinking brain.
• Clients who might be finding it hard to know when and how they are masking may benefit from being paired with a clinician who can talk about their lived experiences after years of masking. Hearing examples and possibilities can help clients to separate things out.

5. Location

Our screening call clinicians identify and provide guidance on whether there are clear reasons why we would recommend a client has an in-person or online assessment.

We have clinicians who can offer assessments in person in our rooms in Knutsford and others who offer online assessments.

6. Energy management

I think this is an overlooked factor in most assessment services, but it’s a factor I take very seriously. There are many ways we make sure clinicians feel supported, including how their work supports energy management. It’s important that work gives more energy back (is regenerative), rather than using more energy up (is depletive).

7. Client preference

This isn’t always at the bottom of my list of considerations! It’s actually quite high up. If a client has a strong preference, it’s important to honour that. However, some clients tell me they would prefer a particular clinician due to professional background. This is where I respectfully share all the different factors I’m thinking about when choosing who is right for them.

Your assessment experience matters

The pairing process helps to ensure you have the best possible experience. If you’re being assessed by another service, ask them questions based on the information above.

At Autistic Women, our team are committed to every client. I have never had a single client complain, not even a little bit, about their clinician. We get great feedback about improving aspects of our process, but the feedback about their assessment with their clinician is always outstanding. Thinking as carefully as we can about pairing helps us to get this right.

If you’d like to explore autism and/or ADHD with Autistic Women, click to book a screening assessment. And if you proceed to a full assessment, you’ll know exactly what process we go through to decide who your assessing clinician will be.