Beyond the Basics: Getting a Comprehensive Autism Evaluation for Your Daughter
Concerned your daughter might be on the autism spectrum but unsure where to start? This episode unravels the process of getting a comprehensive evaluation, highlighting how autism uniquely manifests in girls and why standard assessments may miss crucial signs. Learn about essential testing, the power of your parental insights, and how to advocate for the thorough evaluation your daughter deserves. If you're seeking clarity and a confident path forward, tune in to gain the knowledge you need to take the next step.
If you’ve ever wondered whether your daughter might be on the autism spectrum but felt unsure about how to get answers, this episode is for you. Licensed therapists Tiffany Silva Herlin and Allison Jenkins dive deep into how autism often presents differently in girls, and what that means for getting an accurate diagnosis.
What You’ll Learn in This Episode:
- Types of Testing – The difference between psychological and autism-specific evaluations, like the ADOS, a brief, and MIGDAS.
- Parent Partnership – Why your voice and observations are essential for a thorough assessment.
- Advocacy Matters – How to push for the evaluations your daughter needs—even if professionals hesitate.
- Signs Often Missed – Subtle behaviors that may seem harmless but could be key autism indicators.
Getting a correct diagnosis can feel overwhelming, especially when the signs are easy to miss or misinterpret. But with knowledge, advocacy, and the right support, there is real hope for your daughter to thrive. Tune in to learn how you can take those next steps with confidence. Don't wait for things to get worse. Call us now at 855-701-2721 to explore how we can help.
Introduction to Autism Diagnosis for Females
Tiffany: Welcome back to Episode Two. I’m your host, Tiffany Silva Herlin, a licensed clinical social worker. I’m continuing the conversation with Allison Jenkins, also a licensed clinical social worker and the clinical director at OASIS Ascent, a residential treatment program for teens.
In this episode, we’re diving into how autism diagnoses for females can be improved. We’ll explore the limitations of traditional diagnostic tools, why a comprehensive evaluation is so important, and how professionals can better recognize neurodivergent traits in girls and women.
As always, please remember that this podcast is not a substitute for therapy. If you’re seeking support, be sure to connect with a qualified mental health professional.
All right, let’s get into it.
Types of Evaluations Explained
Tiffany: For some of our listeners who might not be familiar, there’s something called a psychological evaluation.
Allison: Correct.
Tiffany: And then there’s a neuropsych evaluation.
Allison: Right.
Tiffany: Which is even more in-depth and comprehensive.
Allison: Exactly.
Tiffany: But even those don’t necessarily include testing for autism, right? You need something additional?
Allison: Yes, you need an additional assessment specifically for autism. There are three common tools used.
Tiffany: Okay.
Allison: One of them is the ADOS.
Tiffany: That’s spelled A-D-O-S, just for our listeners.
Allison: Yes, A-D-O-S. It’s a structured assessment tool that's commonly used to help diagnose autism. But here’s the important part—using the ADOS by itself isn’t enough for a reliable diagnosis.
Tiffany: Okay, that’s good to know.
Allison: You typically need at least two separate measures for an accurate autism diagnosis. I often see evaluations where the ADOS was done and autism was ruled out. But just because the ADOS came back negative doesn’t mean autism can be fully ruled out—especially if the assessment was done years ago, like when your daughter was 10.
Tiffany: Got it.
Allison: So, along with the ADOS, there’s something called a Brief, which is a questionnaire completed by both parents and clinicians. It offers additional insight into behaviors and symptoms.
And then there’s a newer tool called the MIGDAS. I’m not as familiar with that one, but it’s another assessment that’s starting to be used more often.
The Role of Parent Involvement
Allison: The psychologists I work with—some of them use the MIGDAS, some don’t. It’s spelled M-I-G-D-A-S, for anyone curious.
In a thorough evaluation, it’s not just about sitting down with the student for a quick interview. If you ever encounter a psychologist who says, “I’m just going to talk to the student and then give a diagnosis,” that’s a red flag. That’s not a thorough evaluation.
A good psychologist will also speak with the parents, and that’s essential. One of the most important parts of getting an accurate diagnosis is gathering a detailed developmental history. That means walking through all the major milestones with the parents to build a complete picture of what’s going on.
Tiffany: And probably talking to teachers, too, right?
Allison: Yes. If the student doesn’t have an outpatient therapist or if the therapist doesn’t have much insight into the student's behaviors, then the psychologist should reach out to teachers. Anyone who interacts with the student regularly can provide valuable information.
This process is so powerful because it helps uncover things the student may have masked, especially in girls, where masking is more common. You have to go deep to understand what’s going on.
A high-quality evaluation takes time—typically six to nine hours of face-to-face interaction, spread over two days. That’s important to keep in mind. If a psychologist suggests testing your child for a full day straight, that’s not ideal.
Tiffany: Yeah, especially for someone on the spectrum.
Allison: Exactly—or even someone who’s suspected to be on the spectrum. Sitting still and staying engaged for six straight hours is unrealistic for most kids.
Also, peer reviews are a great part of the process. At OASIS, we work with a team of psychologists. Once one psychologist completes an evaluation, they’ll often have another psychologist review it to ensure accuracy and thoroughness.
It’s not just about test scores. Observations during face-to-face time, interviews, and picking up on subtle cues—those are all critical. But here’s the tricky part: as a parent, you have to advocate for a thorough evaluation.
Advocating for Additional Measures
Allison: Don’t just go to a psychologist and say, “I want a psychological evaluation.” You have to advocate for those additional autism-specific assessments, because many girls are incredibly skilled at masking their symptoms.
I’ve even had situations where I specifically request tools like the ADOS and the Brief, and the psychologist pushes back, saying, “Well, we’re not seeing any signs, so why do it?” And I have to say, “This is a request from our entire treatment team. Just because you didn’t see it during your four-hour session doesn’t mean it’s not there.”
At OASIS, we sometimes find ourselves educating the psychologists, reminding them: “You're seeing this student for a few hours. We’re with them 24/7. We’re observing behaviors over time, across settings, and we're seeing consistent indicators of autism.” That broader view matters—so they must take it seriously.
Tiffany: I think a lot of parents feel nervous about speaking up. They might think, “Well, I’m not the expert, so I should just go along with what the psychologist says.” But there’s nothing wrong with asking for those extra assessments. You're not being difficult—you’re being thorough.
Allison: Exactly. It’s okay to say, “Just in case, let’s cover all our bases. I want the most accurate diagnosis possible.”
And if you’re seeing signs at home, keep track of them. Write them down. For example: “We had three major meltdowns after school this week,” or “There’s something unusual going on with food,” or “She’s missing social cues.”
Documenting those patterns helps you bring concrete examples to the psychologist, and it strengthens your ability to advocate effectively.
Understanding the Function of Symptoms
Allison: It’s also important to go beyond just identifying symptoms—you need to understand the function behind them. I think we talked about this in the last episode: symptoms can look like a variety of different diagnoses, but without understanding the why—the history or function behind those symptoms—you can easily miss the bigger picture.
I had a girl come in who appeared neurotypical. She masked really well—smiled, nodded, did all the “right” things. But as I observed her over time, I noticed something: she hadn’t washed her hair. It kept getting greasier and greasier. So I brought it up with her parents, and they said, “Oh yeah, she hates showering. She never wants to wash her hair.”
Okay—so now we’re looking at behaviors that aren’t just quirks. They’re symptoms. And that kind of thing can be really helpful to bring to a psychologist.
Tiffany: And those are the kinds of things that are easy to miss—or easy to dismiss. Like, “Oh, that’s just a minor issue. It’s probably not related.”
Allison: Exactly. You might think, “She just doesn’t like washing her hair,” or, “She’s always been that way.” But when those behaviors have been consistent since childhood, they could be key indicators of something bigger.
Tiffany: I can’t tell you how many times I’ve had a parent casually mention something in passing—like, “Oh yeah, by the way, she does this…” And I’m like, “Wait—that’s important! That one thing could’ve shifted how we approached this months ago.”
Allison: Yes! So if you’re considering treatment—or even just an evaluation—write down everything you’re seeing. Even if it seems small or unrelated, bring it to your provider. It can help so much.
Tiffany: Or even things you don’t think are connected to autism at all—they might be.
Allison: Absolutely.
Tiffany: So let me ask you this—what role does family input play in the diagnostic process?
Family Input in the Diagnostic Process
Tiffany: You’ve touched on this already, but can you talk a little more about the role of family input in the diagnostic process?
Allison: Definitely. It’s interesting—when I bring up the possibility that a child may be on the spectrum, some parents are resistant. I’ll say something like, “I think your daughter might be on the spectrum,” and they’ll respond, “There’s no way.”
Tiffany: Why do you think that happens?
Allison: A few reasons. Sometimes parents will say, “Well, we have a cousin or a family member with autism, and my child is nothing like them.” And that makes sense, because autism is genetically linked, so there’s often another family member on the spectrum. But I always say, “If you’ve met one person with autism, you’ve met one person with autism.” It looks different in everyone, especially between boys and girls.
There’s often denial, sometimes even anger. Parents are overwhelmed. They might be thinking, “So now my child is just going to use this diagnosis as an excuse for their behavior?” And I try to reframe that—“No, this isn’t an excuse. It’s an explanation. It helps us better understand what’s going on.”
And honestly, it’s scary for parents. When you hear something like this at age 14, you might think, “How did I miss this? There’s no way I missed this.” And that realization can bring up a lot of guilt.
Tiffany: Yeah. And I still think there’s a lot of social stigma around autism. People feel anxious or fearful—“What does this mean? What happens next?”
Allison: Absolutely. Parents wonder, “Will my child be able to function as an adult? Will their life be limited?” Or they start comparing—“Will this look like that other family member who needs a lot of support?”
Tiffany: And then there’s the deep emotional piece: “Did I fail as a parent?” Or “How will this change our relationship?”
Allison: Yes. And even, “This isn’t the child I pictured having.”
Tiffany: There’s so much grief and loss in that moment.
Allison: So much.
One thing I always point out—and we talked about this in the last episode—is how easy it is to confuse diagnoses like borderline personality disorder, depression, or anxiety with autism, especially in females. Parents often feel more comfortable with those other diagnoses because there’s this sense that they’re “treatable,” that they can be fixed.
But autism feels different. There’s fear around it. Parents wonder, “If my child’s brain works differently, how in the world does treatment even help?” There’s this deep desire to fix things, but autism isn’t something you fix.
Tiffany: Right. Autism isn’t something that needs to be “cured.” It’s the way the brain is wired.
Allison: Exactly.
Tiffany: And trying to make someone fit into a neurotypical mold—it’s like forcing a square peg into a round hole. You just can’t do that. Instead, we have to adjust. We have to understand their unique needs and support them in ways that make sense for them.
That’s why this conversation is so important. In our last episode, we talked about how females are underrepresented in autism research. That lack of representation trickles down—even professionals can miss neurodivergent presentations, especially in girls.
Allison: Especially in girls. Absolutely.
Need for Better Representation in Research
Tiffany: This conversation really could go on and on. We need better representation, especially in research. We need more of it. And we need to be talking about this more, educating not just parents, but professionals too. Because this is something we’re missing.
Allison: Yes.
Tiffany: And we’re doing a disservice to so many young women.
Allison: I think about the girls I’ve treated over the years—many of them walked away with a borderline personality disorder diagnosis or were labeled with borderline traits. But we missed it. And now they’re in their twenties, and it just makes me sad. It’s only now that we’re starting to see what was going on. And there’s hardly any research to guide us. It feels like the Wild West—we’re just trying to figure out how to get these girls accurately diagnosed so they can get the treatment they need.
Tiffany: Yeah.
Allison: And I want to pause and say—while some parents resist the diagnosis, a lot of them feel relieved when they hear it. There’s a sense of, “Finally, we have an answer.”
Tiffany: Yeah.
Allison: And I will say this—every single girl I’ve told has said, “That makes sense.” Not one has said, “No way.” Every single one has felt some relief, some clarity. It’s like, “Finally, I understand myself.”
Tiffany: Because it gives you direction. And clarity. Like, “I’m not broken or crazy.”
Allison: “I’m not some weird kid who doesn’t fit in.”
Tiffany: There’s a reason.
Allison: Exactly. And that’s the part I love most about my job. Helping families—but especially helping these girls understand, “You’re not a sociopath. You don’t have borderline personality disorder. You’re not just deeply depressed.” No, you have autism. And it opens their eyes. It’s powerful. I’m proud to be a part of that process.
Tiffany: Yeah. It’s gotta be so healing for those families.
Allison: Yeah.
Tiffany: And for those young women. So, how do you help families who are resistant to this kind of evaluation?
Allison: That’s a really good question. I think it starts with education, just slowly introducing psychoeducation about how autism presents differently, especially in girls. One of the biggest barriers is that there isn’t a lot of research. I can’t say, “Go look up this study” or “Read this article,” because the data just isn’t there yet. So instead, I focus on helping parents understand what they’re seeing, connecting the dots, and giving them the “why” behind the behaviors.
It’s really about reframing—helping parents see things differently. And easing their fears, too. Because the truth is, you can be successful and have autism.
Tiffany: Absolutely.
Allison: These girls are incredible. Their ability to mask and socially camouflage can take them far in life. But part of the work is helping them learn when and how to let that mask down. Because masking all day is emotionally exhausting. So we teach them how to recognize when they need a reset. Like, “You just gave a big presentation? Great. Now your brain needs to rest. You need time alone before jumping back into the next social situation.”
Tiffany: Yeah, that makes a lot of sense. Could you leave our listeners with a story of a family you’ve worked with—someone who came in misdiagnosed—and walk us through what that process looked like?
Case Study: Misdiagnosis and Recovery
Allison: I had this girl who came in, and she was one of those “question mark” kids, you know? The education consultant reached out and said, "This girl’s been diagnosed with bipolar disorder and major depression. She’s now reporting hallucinations, has been hypersexual, and there are concerns about substance use. We’re just not sure what’s going on." So, she came in, and with the structure and routine of our program, she started thriving. All those behaviors we had been hearing about—nothing showed up. At home, she had been a major self-harmer, had to have music 24/7, struggled with candy cravings, and had stomach issues.
She was also one of those girls with intense eye contact, which is a big clue.
Tiffany: Okay.
Allison: So I started suggesting to the parents that I thought she might be on the spectrum. And they were like, “No way.” So I asked them, “Why do you say that?” And they explained that they had adopted two sisters. One was on the spectrum, but they insisted that this girl was nothing like her. They were resistant to the idea. But I pointed out that the biological mother of both girls was the same, so there was a genetic connection. Still, they weren’t buying in.
After a thorough testing process, with the mom challenging everything, the results came back, and I told them, “I think this is autism.” The girl herself was so relieved. But the mom still couldn’t believe it.
Tiffany: I can imagine.
Allison: Yeah. So I worked with the parents, walking them through all the symptoms, explaining the testing, and helping them understand what we were seeing. It took a lot of education, especially since autism looks so different in each person.
By the time they left, they had set up an aftercare plan that was specifically geared toward neurodivergence. They got her into ABA therapy, which was really helpful. And now, she’s thriving! I heard from them a year later, and they told me, “She’s doing great. She has special accommodations in school, she’s attending every day, and she’s learning how her brain works.”
Tiffany: That’s amazing!
Allison: It is. She even used to dislike her sister, but now they’re working through their relationship. Oh, and she’s also horse jumping now!
Tiffany: What a fantastic story to share with our listeners—that there is hope!
Allison: There is so much hope.
Tiffany: Yeah.
Allison: And this was a girl that the educational consultant had told me, "She's going to need long-term care."
Tiffany: Really?
Allison: Yep, they said, "She’s going to need long-term." But she went home after just 90 days.
Tiffany: That’s amazing. For our listeners, OASIS is a short-term residential treatment program. Some kids do go home after completing their stay, while others may need further treatment, depending on their individual needs. What a fantastic story.
Allison: Oh. And when the parents started understanding her quirks and buying into the diagnosis, they said, "Now we see it."
Tiffany: They could finally see it.
Allison: Exactly. They said, "Oh my goodness, yeah, we see it now. It’s different from her sister’s presentation, but it’s still autism." It was about helping them understand that.
Once they started connecting the dots, they recognized, “Oh, she’s rigid. She’s just rigid in different ways.”
Tiffany: Yeah.
Allison: Exactly. And it was just so fun to watch. I love this work. I love helping families understand these nuances.
Tiffany: I can tell that you're so passionate about this work.
Allison: I am.
Tiffany: And passionate about helping the people you work with. I also love the phrase you said in a previous mini-series, “If you’ve met one person on the spectrum, you’ve met one person on the spectrum,” because that is so true. Having worked with many, I can relate to that.
Allison: Yep, exactly.
Advocating for Proper Diagnosis
Tiffany: To summarize what we've talked about, parents who suspect that their child may be misdiagnosed and may need an autism spectrum diagnosis—what should they do? What testing can they ask for and advocate for?
Allison: A thorough battery of tests.
Tiffany: Exactly. And in our next episode, we'll be discussing what life is like after an autism diagnosis. How do families move forward? Stay tuned, listeners, and thank you again for joining us.