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Give us a handshake

Give me a codfish is an expression known to many, meaning to shake hands. At this moment it is a somewhat forgotten behaviour considering the current moment we are living. And talking about codfish, it is said that there are a thousand and one ways to cook it. Just like handshakes. And so was the Autism Spectrum Disorder diagnosis process itself. That was quite a leap, wasn't it? I'll explain it all.


Some of you will know the unique ability of my boss Dr. Nuno Lobo Antunes to make an autism diagnosis with just a simple handshake, right? If you don't know, you must have at least heard about it. I can tell you that a handshake is never just a handshake. Just like a kiss isn't either if you think about it. The contact through the handshake leads to the need to approach the other with a certain intention. And we can tell if the other has made a similar reading of this intention of ours, or not. Or if they know what procedure to perform in such a situation. Or how to do it. For example, do you smile and make eye contact or not? And the handshake itself, some will ask. There is like a whole science behind the handshake and what it can send back. Whether it's the fact that the other person's hand may be sweaty and this may be an indicator of some discomfort or anxiety. In addition to the much or little force used in the mechanics of the handshake itself. Or the confusion in the interlacing of the hands, which may lead us to some difficulty of a more visuospatial nature. This description alone leads us to believe that a handshake is enough for diagnosis, some people think. But it is not. Even though everything I have said is important. And not to forget that the handshake itself is given in a certain context. And so, picking up the client from the waiting room is an important and very informative process.


Beyond the handshake. Some of the colleagues working in the autism field, and especially those who have been doing it for some time, feel that they have a greater sensitivity and speed in the process. How many times have we heard someone say - it didn't take more than a few minutes to determine that that person has a diagnosis of Autism Spectrum Disorder!


But don't get the idea that this is an arrogance of health professionals. You see, we all rely on what might be called first impressions to determine who that person we are interacting with is.


And now there is even talk of using Machine Learning, machines and algorithms to carry out diagnosis in autistic children. And no, I don't think it's through handshakes! But if diagnoses can be made quickly by a machine, can they not be made just as quickly by a person?


Health professionals who make autism diagnoses say that in some situations, not all, they are made almost immediately. Health professionals formulate a set of hypotheses at the very first contact with the person. And these first clinical impressions can be said to be this initial diagnosis, which has clear implications for the early detection of Autism Spectrum Disorder.


As I have already written in previous texts, the Autism Spectrum Disorder diagnosis process is complex, time consuming, involves several intervening parties, information and assessment tools. Even so, this does not invalidate the fact that these first clinical impressions are made. It is part of the process to put forward diagnostic hypotheses which are then tried to validate or not.


Is the first contact with the person important? Yes, it is important. And in the case of a screening evaluation for an Autism Spectrum Disorder, I dare say it is even more so. If we think that a characteristic found in autism is related to the greater difficulty in a first contact with an unknown person. This moment will certainly be informative. But this will certainly not be the only fundamental moment in the assessment. So, rest assured that the assessment will not take 5 minutes. It is fundamental to be able to understand the questions of diagnosis, but not only these. It is fundamental to be able to characterise in a more in-depth way the person and all their characteristics, difficulties and competences. In addition, many people on the Autism Spectrum have greater social skills. Besides, the variability in the behavioural expression in autism is so great that a person may establish an adequate initial contact in those same first five minutes. And if we were to base ourselves only on this information we would certainly be making a mistake.


Even so, this idea has implications for clinical practice in the area of autism. If we think that there are still a certain number of situations that remain undetected despite the fact that people are seen more than once by health professionals. It is important to think why certain professionals need so little time to be sure about the diagnosis. Surely many will think about the career that many health professionals have seeing autistic people in their professional practice. If we go back to my boss Dr Nuno Lobo Antunes, certainly his professional experience associated to his sensitivity will be a great indicator. But we also need to think about the training process of the numerous health professionals who, not being in specialised services for autism, are still able to receive them. It is fundamental to think that the training process needs to be rethought to better help them to achieve this capacity.


But the ability to make a diagnosis so quickly also allows one to continue the evaluation process, but at the same time to indicate so that the person can start the necessary intervention. And in the case of children, this step is fundamental.


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