What You Need to Know about Autism and ADHD Evaluations

ADHD and Autism evaluations

Many people are realizing as an adult that they have traits that warrant an Autism and ADHD evaluation. There is no specific test for ADHD or autism. There are screening tools that can help a provider rule in, or rule out, these neurodevelopmental conditions, but a definitive diagnosis cannot be based on a single screening tools (or even multiple screening tools). Diagnosing ADHD and/or autism should be based on clinical observation and indicators, which screening tools can help support. If a provider tells you have, or don’t have, ADHD based only an ASRS v1.1, it may be worth seeking another opinion. If a provider tells you that have, or don’t have, autism based solely on a screening tool, you may wish to consider a second opinion. Screening tools, by their very nature, are not diagnostic.

Genetic testing for medications

Some clients who undergo an Autism and/or ADHD evaluation will receive a recommendation for medication. There are tools, such as Genomind or Genesight, which measure how specific enzymes metabolize medication, but these tests will not indicate which medications will work for you or if you will or won’t have side effects. There is a super family of enzymes called CYP450 enzymes, and these enzymes are responsible for metabolizing about 80% of all medications, including psychiatric medications. There are 57 known cytochrome enzymes in this enzyme family. Tests like Genomind measure 6 of these enzymes. These enzymes are responsible for metabolizing medications, mainly in the liver. These tests will indicate if you are a normal metabolizer or a slow metabolizer. A medication indicated as having impaired metabolism may still work best for you, but you may need an adjusted dose. A medication may be metabolized normally but cause intolerable side effects.

These kinds of tests will also tell you if you have a MTHFR gene mutation. The MTHFR gene converts folic acid to methylfolate, which is needed to help the body produce neurotransmitters like serotonin, dopamine, and norepinephrine. Everyone has the MTHFR gene, but those with a gene mutation may need l-methyfolate supplements, which is the usable form of folic acid, since the body cannot convert folic acid adequately itself.

These tests can be helpful to help understand medication metabolism, but they cannot dictate treatment. They should be used as tools, but shouldn’t replace clinical judgement. Someone may be a poor metabolizer of SSRIs, but that may still be the best medication classification to help treat their symptoms. A medication may be metabolized normally, but may not alleviate any, or all, symptoms.

Levels of Autism support

Autism is a spectrum, and some people who are diagnosed may also receive a “level.” Levels refer to the amount of support a person needs, not the severity of their autism. Autism is not diagnosed as high functioning or low functioning, though many people, and even providers, use that language frequently. Levels of support can change over time. Someone with Autism may be very independent and autonomous in most areas, but may be completely non verbal, so they require a moderate or high level of support. That same person may later learn to use a communication device, and their level of support may now be level 1, instead of 2 or 3. That does not mean they are less autistic than they were previously.

Many people attempt to communicate the severity of their autism by using shorthand such as “I have level 1 Autism.” This can be misleading, however, in that the level of support needed does not necessarily correlate with the severity of autism being experienced. It can also be misleading on that Autism, in itself, does not have levels – only the support needed is communicated in levels. Often, adults seeking a diagnosis are not told the level of support they need, as the support levels are typically used as a tool to seek support from a school or to justify the need for a type of therapy, like occupational therapy. Levels of support are a snapshot in time and can change day to day or from situation to situation. The most important takeaway is that Autism is not diagnosed in levels.

I hope this information is helpful and helps you have the language you need when discussing your needs with a provider.