“I love that I have a job that brings good into the world”

Dr. Mandy Steiman, clinical psychologist and diagnostician, talks about what drives her work, misconceptions about standardized autism assessments and why empathy is key to her practice

Dr. Mandy Steiman, clinical psychologist, specializes in the assessment of autism and associated diagnoses at the Azrieli Centre for Autism Research (ACAR) Clinic at The Neuro.

She trains students and professionals from a wide range of disciplines in the use of diagnostic tools, including the Autism Diagnostic Observation Schedule – Second Edition (ADOS-2) and the Autism Diagnostic Interview – Revised (ADI-R).

Her goal is to train professionals to provide high quality, evidence-based care while employing an empathetic and collaborative approach with patients and their families.

What motivates you in your work?

Every day I ask myself, “How can I do this better?” I want patients and their families, research participants, and trainees – both students and professionals – to have the best experience possible.

I try to approach my work from many angles and see things from other people’s perspectives. How would they experience this moment? How can I make this message clearer? How can I best support this person?

Another big inspiration is the ACAR Clinic team and our extended network. Everyone is so talented and brings different areas of expertise. This allows us to grow and learn from each other, which in turn brings great benefits for patients and research participants.

For example, we have participants who are now young adults, who have been part of our research program for years. When they need guidance regarding a clinical need, they can call our team and get navigation services (meaning, guidance on how to navigate the healthcare system).

I’ve had families tell me, “Thank you for being here for us” when they couldn’t reach their family doctors or needed help filling out a form for disability funding.

It feels great to know that we are doing everything possible to help support these individuals and their families. I feel proud to be part of a team that isn’t afraid of going that extra mile.

It’s a little corny, but I love that I have a job that brings good into the world.

I believe that by integrating clinical care and research with our very human approach, we get to do “double-good” by helping our patients while also contributing to science, which will in turn help future patients and families.

You specialize in using and training others on standardized tools for diagnosing autism. Why are these tools important in the field? Have you encountered any misconceptions in your practice?

This is a great question! There are so many misconceptions about tools for autism diagnosis.

One pervasive misconception is that using a specific tool, such as the ADOS-2 or ADI-R, is the most important part of diagnosis. As a trainer for these tools, of course I think they’re incredibly useful. That said, tools for assessment are like any other tool in your toolbox – they don’t do the job on their own!

There is no replacement for experience and lots of practice. What we call the “best estimate clinical diagnosis” is more important than the results from any measure.

If a tool is being employed, being a good diagnostician involves knowing the history of a tool, its strengths, and its limitations.

Knowing how to conduct standardized assessments is very important, but it’s just the jumping off point. The interpretation of those results, which takes everything about the patient into context, is the real work of diagnosis.

At the ACAR Clinic, our team has a wealth of experience with underserved and medically complex populations, those for whom the diagnostic tools don’t always work the way you’d expect.

We need to think of the patient as a whole person, not just a score on a test. Identifying a patient’s needs and goals for the assessment, and trying to meet these, is essential.

And our training programs help to shine a light on this critical process.

Mandy Steiman with patient at ACAR Clinic

Can you expand on this human-centric approach?

When people come to the ACAR Clinic for help, they are people first, before they are patients or research participants.

We consider people and their families as experts in their own lived experiences and part of our team. And so, diagnosis is not something that is done “to” them, but becomes a group initiative, carried out along “with” them.

Listening is the first step to understanding, and I think we do a good job of this.

I make sure to ask our patients: "What are your goals?" and tailor their diagnostic assessment and feedback to address their specific needs.

After each session with a child, for example, we ask parents, “Did we get a good picture today of what you see at home?” And when giving results from an assessment, we check in to make sure the information fits with what the patient is experiencing.

We’re not afraid to ask, “Did we get this right?” and elicit feedback from our clientele.

Overall, I aim to give people the kind of care and service I would want for myself or for a close family member. This sometimes means we take more time, but down the line, this saves time as the patient’s needs are met and they don’t have to bounce around in the healthcare system because they didn’t get the answers or support they needed.

We’ve seen patients and research participants who were thought to have an intellectual disability, but as it turned out, no one had bothered to give them an IQ (cognitive) test or they were deemed too “difficult” to test! After we do the testing, we see that assumptions had been made without gathering all the data.

How can professionals benefit from your training?

As an academic medical centre affiliated with The Neuro, McGill University Health Centre and McGill University, the ACAR Clinic is in a great position to share information about current research literature and practices.

Our experience with tertiary care patients and with diverse populations also means that we are able to draw from a broad range of real-world examples and to offer solid clinical recommendations. This approach really benefits our trainees.

We also get a broad range of new and experienced practitioners from private and public sectors who join our workshops locally, from other provinces and internationally. Among them, there are psychologists like me, but also pediatricians, speech-language pathologists, researchers, and brilliant students from a variety of disciplines. This provides an opportunity for everyone to learn from one another and build on diverse perspectives.

I like to teach people about standardized assessments, but the idea is to be very practical as well. I reserve time to discuss case studies that don’t fit the “standard” and talk about professionals’ day-to-day experiences, like for example, “What should I do if a patient needs an interpreter? How do symptoms of ADHD or anxiety come into play when interpreting ADOS-2 results? How can I collaborate with patients and their families as partners in the diagnosis process?”

Ultimately, our workshops help equip our participants to carry out their clinical evaluations with greater confidence – knowing that their training is founded in the latest research findings and current advances in clinical care practices.

Building a community of shared learning

The ACAR Clinic is hosting several upcoming professional development and training opportunities to enhance the skills of new and experienced clinical autism professionals, and build a community of shared learning, support and expertise:

Learn more about the ACAR Clinic’s Clinical Capacity Building Program online.

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The Neuro (Montreal Neurological Institute-Hospital) is a bilingual academic healthcare institution. We are a McGill research and teaching institute; delivering high-quality patient care, as part of the Neuroscience Mission of the McGill University Health Centre. We are proud to be a Killam Institution, supported by the Killam Trusts.

 

 

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