How might young people communicate their expectations of relationships during ADOS assessments?

Recent national developments have seen the rise of distinct Autism Assessment Teams (AAT) within NHS Child and Adolescent Mental Health Services (CAMHS) as a way of managing the increasing prevalence of autism amongst young people (Newschaffer et al., 2007, p. 151). Young people (YP) with autistic symptomology are referred into the AAT for assessment and diagnosis. Currently, under Nice guidelines (NICE, 28 September 2011), the AAT does not include Child and Adolescent Psychoanalytic Psychotherapists (CAPPTs). This study aimed to explore possible CAPPT contributions to the AAT, YP and wider network, through asking the question ‘How might YP communicate their expectations of relationships (EoR) during the Autism Diagnostic Observational Schedule (ADOS)?’, which is one assessment conducted by the AAT. Participants included 5 AAT clinicians, 7 YP (4 females and 3 males) aged between 9 and 15. Data was gathered from 7 transcribed video and audio-recorded ADOS assessments. Discourse Analysis, specifically ‘Subject Positioning (SP) Theory’, was then applied to analyse the data, revealing fifteen SPs. Psychoanalytic understandings of communication and EoR were then applied to the SPs. Four main EoR were identified, demonstrating expectations that relationships would be characterised by: 1. Intrusion and exclusion 2. Aggression and destruction 3. Criticism, judgement, unreliability and untrustworthiness 4. Sameness Findings suggested the ADOS assessment to be an emotionally saturated and meaningful experience for YP, which evoked various unconscious EoR, and primitive survival anxieties. The assessing ADOS Clinician (AC) unconsciously contributed to the EoR and anxieties communicated. These findings suggest a CAPPT could provide valuable understanding of the unconscious emotional world of the YP undertaking the ADOS, and the possible impact on the assessment outcome, the AAT and wider network surrounding the YP. Key words: Communication, Projective Identification, Expectations of Relationships, Transference, Countertransference, Autism and ADOS Word Count: 291