The Value of Diagnosis: It’s Never Too Late to Get It Right

When Susan Boyle came to audition on Britain’s Got Talent, she wowed the audience with her amazing performance. She was an instant celebrity. Her audition went viral and everyone wanted to see her perform live. However, she was quite odd and exhibited a great deal of anxiety. She was in her 50’s and now that she was a public figure, she was extremely vulnerable to being teased and bullied in the public domain. But somebody recognized that this woman, who seemed shy and quirky, was probably on the Autism Spectrum. She was eventually seen by an expert and diagnosed with Asperger Syndrome, a form of Autism Spectrum Disorder (ASD). As a child, she was labeled brain damaged and was bullied by the other children. Known as “Simple Susan,” she was teased mercilessly by the other kids. The crippling anxiety and mood swings Susan struggles with now has a name and can be attributed to Asperger’s. Susan is tremendously relieved by the label and knowing what is going on in her brain has helped to function in the world, though she still needs a great deal of support and life can sometimes still feel quite challenging for her.

In my work as a consultant I find that many of the adolescents and young adults I work with have lived with a number of different labels: Oppositional Defiant Disorder, Attention-Deficit Disorder, Social Anxiety or other diagnoses. Somehow, treatment has not led to improvement for many of these young people. Then I see the different pieces that start to weave the story of their lives – they have always struggled socially; they have unusual sensory sensitivities; they are quirky; they may have a special talent – math, science, singing, art, but somehow cannot get on track with their lives. Many times, digging in to explore these pieces can result in an ASD diagnosis. Once this diagnosis is made, treatment can be aimed at improving the different aspects of ASD, and what I’ve seen is that things get better. Maybe not immediately, but over time we can see consistent movement in the right direction. Families have shared with me that they no longer feel like they are running around in circles not getting anywhere with their children. Instead, they are finding ways to be more and more successful. Rather than seeing their behavior as willful and manipulative, we can see these challenging behaviors as a manifestation of ASD.

If therapists and others can look at these behaviors through this different lens, the lens of autism, new treatments can be used, and we can start to address the behaviors from that perspective. From this, we can get different outcomes, and the adolescent, young adult or even older adult, finally feels like they are being seen, perhaps for the very first time.

We all need the experience of being seen and understood. For Susan Boyle, I suspect that the thing that has changed her life most is not as much her fame and newfound income, but her newly discovered understanding of herself and the ability to work on these things. In therapy we talk about mentalization, or the process by which we make sense of each other and ourselves. As a psychologist and diagnostician, I truly value getting the diagnosis right, so we can help our clients have more fulfilling lives. As one of the mothers I work with shared “there is always hope and can be amazing healing along the way.” That’s why I keep doing what I do.