Canada has a serious problem with accessibility of autism assessments for adults. Seeking an assessment for free can mean being on a waitlist for many months, or over 5 years in some provinces! This is common in Edmonton, for example. Doing a private assessment not only can be extremely expensive, but many of those private options also have huge waitlists.

I’ve spoken with large private Autism assessment agencies in Ontario that have adult waitlists so long that they won’t even put you on the waitlist (true through 2022 and still into mid 2023, at time of last updating this). In fact, when I made requests for information to numerous similar organizations, I got no response from over 70% of the places I contacted—and I’ve heard the same thing from many people from all across Canada.

A public assessment is only an option if your family doctor (or psychiatrist etc.) doesn’t simply dismiss the possibility that you’re autistic, often citing lots of old stereotypes or just incorrect information about autism when doing so. Even in the private practice realm, many therapists are hesitant or unwilling to work with autistic adults. Those in private practice that are interested and willing, well, private practice is an awkward mix of healthcare and business. What happens when the public healthcare system is failing a group of people, but it’s also hard to make a living charging that group what it can (on average) afford for the services they need?

I don’t think there’s any simple answer to that question. Some private practitioners sometimes offer a sliding scale to some clients, or even “pro bono” (i.e., free) services a few times a year, but autistic adults are, all too often, unemployed or underemployed. The current state of assessments and support for autistic adults is not enough and it’s frustrating.

I created my assessment service for autistic adults with these problems in mind. I don’t think I’ve solved them, but I believe I offer a somewhat reasonable option in the private world. I do a number of things that allow me to offer more cost-effective autism assessments to adults in Alberta, Nova Scotia, and New Brunswick:

• Remote-only practice keeps my costs relatively lower (no office, parking, commuting, etc.)

• I offer a free self-screening. Screening before a full assessment is ideal, because it helps ensure only people who seem appropriate for that full assessment partake in it (and its expense).

• While a thorough psycho-educational assessment can be an important aspect of autism assessments, I only offer services to adults whose support needs are relatively lower, whose cognitive functioning doesn’t complicate or obviously preclude the possibility of being autistic. Charging everyone for extensive cognitive assessment that they don’t need is a good example of business priorities surpassing client wellbeing. Thorough psycho-educational and/or cognitive testing takes a long time thus is expensive.

  • I don’t mean to be dismissive or exclusionary toward autistic adults who want or require more support during their assessment; remote assessments with a single clinician are only appropriate for certain kinds of cases. Please review my FAQ page, especially the sections on “Is an online assessment appropriate for any level of clinical complexity?” and “Are remote/online assessments appropriate for everyone?” for full details.

• I offer a brief report option, which takes less time to write thus is cheaper.

  • I surveyed a large online autistic community and some people were clear that they knew they were autistic but needed a formal diagnosis to access some service or accommodation—they didn’t want to pay me to spend hours writing extra things in their report that they didn’t care about. For numerous reasons, they were uninterested in a lengthy report and figured they should be able to pay less to still get a thorough assessment and the diagnosis that they needed—but not pay for the parts they didn’t want. I agreed and made the change!

• I send all clients an extensive list of general recommendations for late-diagnosed adults which contains a mix of evidence-based suggestions, voices from the autistic community, and some of my thoughts to ‘glue’ these pieces all together (I also count as a voice from the autistic community!). I provide detailed personalized recommendations in the comprehensive assessment but do not include these in the brief report to save time/cost.

  • While I regularly update the general recommendations document, I already spent the time to create it, so it doesn’t cost me any more or less time to send it to all clients regardless of which report option they paid for. I frequently send it to potential clients who contact me but then don’t proceed for various reasons. It’s what I wish someone had handed me when I was late-diagnosed.

I know it’s not enough but I’m trying. This service is my current best attempt that is still based in the real world. My services are always a work in progress, and I do update things regularly and seek feedback from the community that I incorporate whenever possible (often a few changes each month, to various aspects of the process).

~Iain