This is a special blog post written by Help and Healing Center psychologist Dr. Jaime Long. Jaime is passionate about providing neurodiversity-affirming psychological evaluations. She wrote this blog to help explain information about her assessment process. She wants people who are considering an evaluation with her to understand how she works so they can feel as comfortable as possible as they plan for an evaluation appointment.

How do we assess for autism when there is a high level of masking, especially among women? I want to share this information for prospective clients, since this can be a source of significant anxiety for many people. I am very familiar with masking and we approach our assessments in a way that allows you to unmask and share your inner experience. First of all, I have done autism assessments in person and I have done them remotely. Folks seem more comfortable doing them at home. It takes the stress off of having to go to a new place and you can be in a familiar environment. It’s often nice to have a pet nearby. You can also see that I am comfortable in my environment and will often have a cat roaming around. I understand that in anxiety-provoking situations people may need to stim, so feel free to pace, rock, play with fidgets, whatever makes you feel comfortable. If you have a favorite stuffie, I want to see it, and I can show you whichever one I have which is hanging out on my desk. People often feel safe to drop the mask with me.

Also, I am neurodivergent and would consider myself high masking as well. I identify a lot with what you are saying so I can tease out the subtleties, and I understand things other clinicians may not understand. For example, I would probably rather die than talk to my neighbors. They are nice and I am capable of making small talk but I hide from them all the time. People do not understand this because I have a friendly and bubbly persona but I literally hide from people. So when you say you don’t like initiating conversations, I can see where you are coming from. I can ask the appropriate follow up questions to pinpoint what’s going on.

Also, I am not basing my diagnosis on how you interact with me. When I conducted autism evaluations in person in the past, before I better understood how autism presents in high-masking adults, I used an assessment where I literally had to rate people on eye contact and body language, but so many autistic folks can mask and do that. So I ask about your inner experience in the evaluation. So often, autistic folks have a flurry of activity under the surface concerning social interactions. They have studied others, watched you tube videos, mimicked others. There’s often a constant analysis of social interactions—what does someone’s body language mean, am I holding my arms correctly, is my eye contact too intense, did I over share. There’s a lot of planning of conversations and then mulling over conversations afterwards.

For neurotypical people, it is like they are running on an automatic transmission when interacting. It’s more on manual with neurodivergent folks. The wheels are grinding under the surface and it’s really draining. I ask questions that get to that. I want to know your inner experiences. Most people leave the evaluation feeling like they were heard and understood. People are incredibly brave sharing things with me that they have never told anyone, things that are “odd” and they think they will get judged for. I’ve heard it all and you can tell me anything. I take a kind and gentle approach and people open up to me. I have also found completing the autism planner (a document we send clients when they schedule the evaluation that lists topics we will ask about) very helpful. After interviews, I will review those notes again and I will see things that you may have not been comfortable discussing in person, and I’m able to get the full picture. You can also email me after the assessment as things come up.

In terms of high masking, I often see women that have successful careers, and no one would suspect how much they are struggling. But they come home and collapse. They struggle with things like filling out forms, showering, and taking out the trash. People on the outside wouldn’t know they are struggling but folks feel comfortable enough to tell me these things. People may be able to go to a work event and socialize but they may not be able to do anything for days after. I look at your functioning in all areas, not just if you were a straight A student, have a graduate degree, or a successful career. I know you can have all those things and still be autistic or have ADHD. Some doctors will rule you out as having a diagnosis if you can hold a conversation or excel in certain areas of your life, but I know firsthand there can be a lot of struggles under the surface. The question is, what do you have to do to have that success? Does it take everything you have? I want to know if it costs you, and I want to help you find a way to make your life work for you.

I learn a lot from clients and I appreciate you being vulnerable with me and unmasking so I can provide you with the best evaluation possible.

Dr. Jessica Myszak and Dr. Jaime Long have significant experience performing psychological evaluations with children and adults. They offer both in-person and telehealth evaluations for children, teens, and adults looking for answers. In addition to seeing clients on the Chicago North Shore, they are able to work with families who reside in Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Utah, Virginia, Washington, Washington DC, West Virginia, Wisconsin, and Wyoming! Dr. Long is also now available to see clients in New York and California. If you are interested in learning more about potentially working with them, you can visit their website here to get the process started.