Illnesses happen. Sometimes, your child happens to get sick right before an evaluation or your clinician gets sick. We'll work it out! Sick policy for in-person appointments: An appointment will be rescheduled if your child is feeling unwell. It is important your child feels their best during testing. An appointment will be rescheduled if anyone has signs of a contagious illness (e.g., fever, significant congestion, unusual sneezing, lethargy, vomiting, diarrhea, etc.). If I have known flu or COVID-19 exposure, I will try my best to reach out before your appointments to give you the option of proceeding or rescheduling your appointment. Masks are only required per CDC guidelines after COVID-19 or exposure. It is possible I may need to wear a mask during the evaluation or that your child may need to wear one. The effect of people wearing a mask during autism testing is unknown. I have successfully completed many evaluations while wearing a mask, however. I will sanitize all materials and surfaces in my office between appointments. I have received a full vaccination series for COVID-19 and I receive the flu shot each fall. While this does not entirely eliminate the risk of COVID-19 or the flu, the CDC says it is effective for reducing spread of the viruses. I also agree to let you know if I think I may have COVID-19 or the flu, as well as if I've had a known exposure.

All evaluations are comprehensive, meaning they include many pieces of information. Every evaluation starts with an "intake interview", which is when you're asked questions about your child’s development, the history of concerns, and their current strengths and challenges. After this, I complete testing with your child. All evaluations also include a "feedback" session, where I go through the results with you. For a child 6 or older, here is what a typical evaluation looks like: 1. Intake Interview: The evaluation begins with a 1.5 hour intake interview. This is usually done before the day of in-person testing. Before the intake appointment, you'll complete some online forms. 2. Testing: During testing, I work one-on-one with your child to complete tests relevant to the referral question. Typically, a parent waits in the waiting room and provides support during breaks. Your child will have 3-5 breaks, more or less if appropriate. During that time, they can have snacks, walk around, read a book, etc. 3. Results Discussion: This may happen on the same day as testing or it may happen on a later date. We will discuss any diagnosis given or we will discuss why a diagnosis was not given. We will also discuss treatment recommendations. Results discussions usually last from 30 minutes to 1 hour. You may request an additional results discussion if you would like more time to talk through the evaluation results. If your child is 5 or younger, the process will look similar. However, the intake, testing, and results discussion can happen all in one day. I will also have you in the room with your child during testing rather than being in the waiting room. You can learn more about that process by calling or emailing me!

Are you feeling unsure about what to bring with you? That’s okay! This is a new experience for your family. Here are some things I suggest bringing with you: Diapers and a changing pad (if your child is not yet toilet trained) Drinks in containers with lids for you and your child Non-messy snacks for you and child ​Paper records (e.g., evaluation reports, therapy evaluations or treatment plans, medical records) Jackets in case the office feels cold If your child is 6 or older, bring something to read or work on while you wait (WiFi is available) There are a few things that are not helpful for the appointment. We recommend leaving all of your child’s toys and electronics at home. This is to help us get your child interested in new toys. If your child has significant difficulty leaving a toy at home, that’s okay! Bring it with you and let me know the toy is a comfort item. I also request you do not bring your child’s siblings unless they are an infant that is not yet crawling. Siblings will find the appointment frustrating because they are not able to play with the toys or be a part of the activities like your child that's being evaluated.

I know this is probably the first time your family is doing an evaluation. You may feel nervous and unsure of how to prepare. That's okay! Here are some ways you can prepare for the appointment: Make sure your child is feeling their best and isn't sick Make sure everyone gets a good night’s sleep the night before The night before, organize documents you're bringing with you Pack the things you’re bringing the night before the appointment Keep your normal morning routine the day of the appointment Make sure your child eats breakfast the day of the appointment Double check the directions to the office the night before and plan for traffic You can call or email me directly if you have questions the day before or the morning of your appointment!

I will ask you questions throughout the intake interview and during testing. Thinking about the areas below will help you prepare. It may also help you feel less nervous! Your Child’s Strengths: I want to know what your child is really good at! What do you enjoy about your child? Do they love puzzles? Are they a great problem solver and a fast learner? Are they kind and affectionate? It is so important that I know your child’s strengths. They are a big part of the recommendations I make. It also helps me see your whole child and who they are as a person. I'll highlight your child's strengths throughout the evaluation process and in the report. Developmental History: This includes delays, loss of skills, and slow development. It also includes anything that stands out in hindsight. For example, do you remember you child smiling at you when they were a baby? Did they ask you to play with them or did they seem really independent? I'll also ask about the timing of some developmental milestones, especially in language and play. For example, did they seem interested in playing with other people? Did they enjoy back and forth play with you? Did your child play with toys like you expected? Lastly, I'll be curious about when you first started wondering if your child's development felt different than you expected and why. Family History: I want to know about your support system and who your child is living with. Does your child stay with grandparents while you work? Are you a stay at home parent? Are you and your child's other parent divorced or separated? If you are, I will want to know who lives in both homes, who has medical decision-making authority, and if your child has any other siblings. Lastly, I will ask about diagnoses that run in either side of the family. Medical History: There may be a lot to talk about here or this may be very brief. I will want to know about any chronic medical conditions or issues, as well as any that happened in the past. Did your child have surgery? What about any major illnesses or injuries? Were the delivery and pregnancy easy or were there complications? I will also want to know about any medical testing that's been done or recommended, like genetic testing or a sleep study. Does your child have allergies, dental issues, or vision or hearing issues? I will want to know your child’s current medications and supplements. All of this information helps me rule out other conditions. It also helps me make clinical recommendations. Current challenges: What do you think your child needs help with right now? For example, do you think they need help with expressive language, toileting, making friends, or playing with other people? This discussion is largely parent-led. Bring whatever concerns you have! If something pops into your mind and you are afraid you will forget it, blurt it out! Iwill ask you questions about the following areas: expressive and receptive language, play, social interaction skills, behavioral challenges, tantrums, anxiety or irritability, safety skills, toileting, feeding, sleep, and sensory processing. As you are talking with me, I may ask about behavior we're observing if your child is present. Current and past therapy: I am curious about the services your child is receiving or what you're thinking about doing. If your child is already in therapy, I'll ask about what those providers are working on and how therapy is going. Are sessions one hour weekly? Have they been virtual? How has your child been responding to therapy? I'll also want to know what services have been recommended by other people, as well as the services you're curious about. I'll also ask about your child's school services or if your child will be starting school soon. Symptoms of autism: This will be a large part of the intake interview. It may be helpful for you to learn about autism before you come in. However, don't feel like you have to! I can help you understand the questions and the answers I'm looking for. How specific the questions are sometimes surprises parents. There are two primary areas I'll ask about. One is "social communication and interactions". Questions may include: how your child plays with toys and other people, how your child uses nonverbal communication (e.g., eye contact, gestures), how your child perceives other people's nonverbal communication, and if your child enjoys showing and sharing things with you. The other area is and "restricted, repetitive patterns of behavior, interests, and activities". Questions may include: sensory-seeking behavior, repetitive behavior or language, if your child has any special interests and/or attachments, and how well your child adapts to change and transitions. If you would like more detailed information, give me a call!

I use appropriate, high quality measures for my evaluations. Below is a list of some measures I use. This may change based on your child's age and the referral concerns. ​ Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) Social Responsiveness Scale, Second Edition (SRS-2) Social Communication Questionnaire (SCQ) NEPSY-II Delis-Kaplan Executive Function System (DKEFS) Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4) Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) Wechsler Preschool & Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) Behavior Assessment System for Children, Third Edition (BASC-3) Vineland Adaptive Behavior Scales, Third Edition (Vineland-3) Conners, Fourth Edition (Conners 4) Wechsler Individual Achievement Test, Fourth Edition (WIAT-4) Kaufman Test of Educational Achievement, Third Edition (KTEA) Please call me if you're curious about a specific measure I may or may not use.

After the results discussion, a few things will happen: The same day, I will send you a follow up email with top recommendations and resources. I will complete a written report. You'll receive this, at most, 2 weeks from the results discussion. I will send the report to your child's pediatrician and other providers, if you consent to this. Basecamp offers additional follow-up and consultation with your child's treating providers. This could include: going to a school meeting, talking with an Early Intervention team, calling the pediatrician, and brief or longer-term consultation with therapy providers (e.g., ABA, speech, and occupational therapy providers). Don't be afraid to reach out if you need additional support or have any questions. I would love to hear from you! Support could include a second results discussion, additional support to process the diagnosis, and help getting connected with therapists. My door is always open.

I strive to write detailed and meaningful evaluation reports. There are two main purposes to the reports I write. ​One is to provide you documentation of a diagnosis and enough information to prove that diagnosis. Alternatively, if your child is not given a diagnosis, then the report will give enough information for readers to understand why a diagnosis was not given. The second main purpose of the report is to communicate your child’s needs to other providers. This is especially important for therapists. The information in the report will help them understand your child’s needs and things to consider in their treatment. If you have trouble reading through the report, either emotionally or because of professional lingo, knowing the two main purposes of the report may be helpful. I can also talk you through the report if you have any questions or concerns. Every report will include the following domains: Your child’s developmental and medical history Your child’s current strengths, challenges, and/or delays Parent input and perception Behavioral observations The results of assessments in a way you and other providers can understand A summary of clinical impressions and diagnoses A clear list of any diagnoses given A summary of treatment recommendations, including things to pursue now and to consider in the future

All telehealth evaluations are comprehensive, meaning they include many pieces of information. The process is similar to in-person evaluations, with some differences. Telehealth evaluations are most appropriate for children 4 years-old or younger. Every evaluation starts with an "intake interview", which is when you're asked questions about your child’s development, the history of concerns, and their current strengths and challenges. After this, I complete testing virtually with you and your child. All evaluations also include a "feedback" session, where I go through the results with you. Here is what a typical appointment looks like: Intake Interview: The evaluation begins with a 1 hour intake interview with you. Your child does not need to be present for this. Break: You are given a 10 to 15 minute break. You can use the time to gather some toys for an unstructured play observation. Play Observation: I will have you play with your child with a computer arranged so I can see. I will have you spend time with your child doing whatever interests them. During this time, no demands are placed. This means you are not giving your child instructions and you are instead following their lead. You can point out any behaviors you want us to observe. I will likely ask you some questions based on my observations. Feel free to suggest activities! Break: You are given another 10 to 15 minute break. You can use the time to gather the toys on your list for the TELE-ASD-PEDS assessment. I will send you this list of toys ahead of time to help you prepare. TELE-ASD-PEDS: We will be doing the TELE-ASD-PEDS, which is a measure developed for telehealth assessment of autism. I will guide you through this assessment. Please make sure you have a small, distraction-free space for this (if possible). A small child’s table and chair are helpful if you have them. Some of the toys I will ask you to gather include bubbles, cars, toys for pretend play, and cause-and-effect toys. If you don't have all of the toys that is not a problem. I'm flexible! Break: If I have all the information I need, then your family will be given a 30-45 minute break. During the break, I will review the information I have, finish scoring assessments, and determine diagnoses and treatment recommendations. Results Discussion: To close, you will meet with me again. We will discuss any diagnosis given or will discuss why a diagnosis was not given. We will also discuss treatment recommendations. Feedback sessions usually last from 30 minutes to 1 hour. All telehealth appointments are done using Google Meet, which is HIPAA-compliant. I ask that before your appointment you think about what device you want to use and that you test your audio and video. Also think about where in your home you want to do the evaluation. If I have trouble seeing or hearing you, I will help you troubleshoot it.

Autism is called a "neurodevelopmental disorder". This means it is a difference in the brain that develops in the first few years of life. Symptoms of autism are usually seen before 5 years-old. However, many people are not diagnosed until they are older, especially if their symptoms were not as clear when they were young or if they "mask" their symptoms. In order to be diagnosed with autism, someone must show difficulties in the area of social communication and interactions. They must also show restricted, repetitive patterns of behavior, interests, or activities. Autism is a spectrum disorder, meaning how symptoms look will vary person to person. Symptoms can also change, especially in childhood as a child goes through developmental stages. The level of support a person with autism needs may change over time. If you're met one person with autism, you've met ONE person with autism!

When a diagnosis of autism is made, a clinician should always give you the "level specifiers". These are from the Autism Spectrum Disorder diagnosis in the DSM-5-TR, which is the manual used for diagnosing. The levels specify the level of support a child needs. The levels include Level 1 ("requiring support"), Level 2 ("requiring substantial support"), and Level 3 ("requiring very substantial support"). The clinician should note a level for the two domains of the autism diagnosis: social communication and interaction skills, and restricted, repetitive patterns of behavior, interests, or activities. It's not uncommon for the levels for these two areas to be different! The levels are often misused, although autistic individuals may use them differently. For example, Level 1 does not mean "high functioning" autism" or "mild autism". The levels tell us the support a child needs. This can change over time! It's not uncommon for a child to have Level 2 or 3 needs and then have Level 1 needs as they get older. This is why we value reevaluations at Basecamp Pediatric Psychology.

While some older kids and adults may no longer appear to have autism, they will always meet criteria based on their early developmental history. There is also a common term called “masking”, meaning someone on the spectrum uses strategies that can make them appear neurotypical. Also consider that autism is a spectrum disorder, meaning there are a lot of different ways symptoms can present.

The American Academy of Pediatrics recommends screening for autism at 18- and 24-month well-child visits. Depending on the child, autism can be diagnosed as young as 12 months old, with the diagnosis becoming more reliable around 16 months old. A child must be walking independently to participate in testing for autism. The average age of diagnosis in the U.S. is over 4 years-old, with many people not getting diagnosed until later in life. This can happen for different reasons. Early diagnosis is key for improving long term outcomes. Waiting for a child to “catch up” when they are young may affect long term outcomes, as the child is missing out on vital intervention. I recommend identifying autism before the age of 5 so early intervention can be started.

There are many women on the spectrum. There is some disagreement about whether women need different diagnostic criteria or if the prevalence rate we have is accurate. What we do know is that women tend to get diagnosed later in life, possibly because of “masking” and being conditioned form a young age to show certain social skills. A woman on the spectrum may report anxiety and/or depression before getting diagnosed later in life.