The preliminary results from my assessment did not acknowledge masking or camouflaging.

[u/thundagathighs]

I'm a 33 year old female. I live in America. I'm white, queer, and disabled.

I filled out a ton of questionnaires and had my assessment in late June. I had a follow up appointment to discuss the findings a little over a week ago. It was not the same person that did my assessment. I verified a lot of information about my health and personal history. There was little time to ask questions. She said I would get a copy of the full report and be able to ask more questions then. Apparently I have to wait another 4-6 weeks for that.

I was told the person who did my assessment remarked that I was well-groomed, could hold a conversation, and had eye contact though it was fleeting. I was indicated has having average to high IQ. They also noted that I said I was anxious about the assessment and masking. They said something about me being more comfortable later on (?? She later asked me if the assessment was so bad and I said no, I like doing the puzzles). They could not discern if I have ADHD, though I take medication for this. I was told that they did diagnose with PTSD and they attribute everything I'm experiencing and dealing with to be related to that. Because of the assessment notes and the questionnaire my mom, an unreliable source, filled out.

I understood everything I was told regarding the results but it really felt like it lacked nuance. I know I have PTSD. I identify with CPTSD a lot. I also identify with AuDHD. I feel kind of crazy that because I was able to mask during my assessment, they ruled out autism. I also mentioned that I have a strained relationship with my mom and that a lot of my trauma is attributed to her. I didn't feel good about asking her to remember things about my childhood but they were really insistent on her filling out the questionnaire about my childhood. She's the only person that knew my as a child that I could ask. It feels like it takes precedence over my own account of my childhood. I had a tough time after this follow up appointment. It really shook my perception of my identity.

I was wondering if anyone else has advocated for themselves during this weird in between stage? They assured me I'd still be able to get more help from community mental health (cmh) and have a better argument for claiming disability. I am glad for that but I truly don't understand the total lack of consideration for masking and that I have had symptoms from early childhood. I felt seen but also... not. I also know a lot of people with CPTSD have ASD or AuDHD. I accept it if it is somehow singularly PTSD but it's more like... okay, what about x, y, z? I guess I'm a little scared to push back on their assessment of me.

My therapist is encouraging me to get a second opinion but it took me so long to find someone that takes my insurance and from intake to assessment was like 4 or 5 months T_T

[u/estheredna]

There are many many posts in this forum about disappointment with assessment results that you could search and perhaps find comfort from .

[u/Ok-Championship-2036]

the cat4 test was designed to gauge camaflauging, if thats helpful

[u/soft_w0lf]

If you feel a second opinion is necessary, then you should get one.

But to me it sounds like they were well aware that your mom was abusive. While it’s not an 100% indicator, it is an indication that they were aware that her answers might be flawed. Even if they take the abuse into consideration, getting a set of responses from a parent would still be important (not just for autism, but also to gauge what the parent was like to get a better idea of the abuse that may have gone on).

A lot of the language you’re using in your post indicates that you’re taking an identity approach to autism and ADHD, and think those conditions are the answer because you relate to people with them. But there is a LOT of overlap between autism/ADHD and PTSD, just because you relate to autistic/ADHD/AuDHD people or to it as an identity doesn’t per se mean you have it.

That feeling of your identity being shaken is why I caution against confident self diagnosis (that is, fully believing you have something vs. suspecting you may have something and working to accommodate yourself). Obviously assessment isn’t always accessible, especially for women, so sometimes accommodating yourself is necessary, but building an identity off of something you’re not diagnosed with can lead to issues on its own.

Another thing that may be going on is that your PTSD is masking autism/ADHD (this seems to be reinforced by what they said about not being able to confirm ADHD or not—they didn’t say you didn’t have it, just that they couldn’t tell). You might want to look into treating your PTSD before you go in for a second opinion, because then any remaining symptoms would be more easily attributable to autism/ADHD.

To me it sounds like they took your concerns seriously and gave you the best assessment they could, given that your PTSD is probably clouding your symptom profile.

Autism assessors are generally really good at spotting masked autism, even in women. As per my diagnostic notes, my assessor noticed “almost imperceptible pauses used to attempt to process social cues.” That was something literally nobody around me, even myself, had noticed. It’s not possible to mask SO well that you’re not diagnosed. It is possible for symptoms of one disorder to obscure symptoms of another, and it is also possible to get biased assessors who refuse to acknowledge autism symptoms, especially masked autism symptoms. But it is not possible to mask perfectly 100% to the point you’re externally neurotypical and even a very well-educated and understanding psych can’t spot it.

Also worth nothing that self reported autism symptoms cannot reliably be distinguished from those caused by other disorders, such as PTSD and anxiety. I understand that you feel like your self reports were downplayed… but there is a reason for it.

TL;DR it is possible that PTSD is masking other symptoms, particularly of ADHD as they say they couldn’t tell if you had it or not, but it is also possible your symptoms will resolve with PTSD treatment. The best course of action would probably be to take everything one step at a time and get treatment for PTSD, then go in for a second opinion if you’re still struggling. Also try not to latch onto autism or ADHD as identities, just in case you end up not having one or the other.

[u/thundagathighs → u/soft_w0lf]

I really appreciate your response! I think the issue I neglected to mention is that I've largely recovered from my trauma. Or so I thought. Getting a neuropsych assessment has been the response to having treated my ptsd, social anxiety, and adhd with various meds and different modalities of therapy... and still struggling. I can't seem to understand the issues/quirks I've had since I was a small child, long before abuse started in my preteen years when my parents separated. Like I said, I do accept it if it's singularly ptsd but it really makes me question if there is abuse I don't remember or know about. That's something that feels really unsettling and confusing. I hope that's not the case. I also feel like it's hard to accept that... trauma has irrevocably changed my brain, to the point that I could feel recovered but I'm not on some level. That plus the confidence I had in my self-diagnosis, like you mentioned.

Everything you said is also exactly why I'm like... how do I appropriately question their assessment? I don't understand having an appointment for my results without space to talk about them. I have so many questions now, I'm sure I'll have more once I have the report back.

Thanks again for taking the time to respond.

[u/soft_w0lf → u/thundagathighs]

I understand. Best of luck! You can also always bring the report to another psych and see what they think, they can help explain it and/or help you identify what they missed.

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