#i had so many recordings of stimmy hand things but i could only use a couple

[scriptautistic]

OK so I might be wrong but I recall one of the admins here saying they're French (or that they got diagnosed in France ???)...if I'm not mistaken, could they say more about the diagnosis process & how autistic people are treated in France (do you have accomodations, is there a lot of ableism, etc) ? I'm writing a French autistic character and I'm lacking a lot of information because most of the info about autism in France is in French, and I haven't learned the language.

Hi! You’re remembering correctly, I am indeed French, and I can answer that question.

Autism Diagnosis in France

French healthcare is set up with a primary care system with general healthcare providers(such as general practitioners or family doctors), and then you’ve got specialists, and you’ve got to go through primary care to be able to access the specialists and be reimbursed properly. It works like this for all kind of healthcare specialists, and it’s also the case for autism.

I don’t know the age of your character when they’re getting diagnosed, so I’ll cover different situations. Basically, there are three different times in your life where you can get adressed to a specialized team for diagnosis:

As a young child: It is possible the parents noticed that there was something “wrong” with their child and brought it up with the pediatrician. It is also possible that the pediatrician noticed some developmental delays or tell-tale signs of autism during one of the developmental checkups that are (theoretically) scheduled regularly during the child’s first years.

As a school-age child or as a teenager: difficulties (of an academic or social nature) at school can trigger questions from teachers or parents. Typically, the child would then meet the school psychologist who would do a first screening/evaluation. If the school psychologist thought there was ground for a diagnosis, they’d refer the child to a child psychiatrist.

As a teenager or an adult: Self-diagnosis can lead the character to seek an official diagnosis, they’d then go to a psychiatrist (people younger than 26 can go see a psychiatrist directly, people 26 and older need to be refered by their G.P. if they want to be reimbursed) to talk about it. Another possibility is the character seeing a psychologist or psychiatrist for mental health problems, and the professionnal bringing up the possibility of an autism diagnosis. If it was a psychologist who brought it up, the character would need to go and see a psychiatrist anyway, because only doctors can make official referals to specialists.

In any case, the character would end up seeing a general healthcare provider, who would ask them (or their parents) a lot of question about autistic traits, their impact on daily life and on professional/academic life, etc. If what the doctor hears lets them think that there is ground for a diagnosis, they’d then write a letter to a specialized team, with all the information to justify their demand.

Specialized teams can be composed of psychiatrists, psychologists, nurses, speech therapists, occupational therapists, psycho-motor therapists… There is at least one “official” team per admisitrative region in France (so that means 8 total), in what is called a Centre Ressource Autisme or C.R.A. (which means Autism Resource Center). There can also be teams in other places such as in CAMSPs (Center for Early Medico-Social Action, for children younger than 6), CMPPs (Medico-Psycho-Pedagogical Center, for children up to 18 yo), child psychiatry or pediatry services in hospitals, special evaluation units, or coordinated independant practices.

Your character can probably count a couple of months before being refered to one of these teams. It’s going to be quicker for a young child than for an adult, because it’s considered as more of a priority. For me it took 6 months but that’s because they lost my contact info, I think one-two months is more representative.

As for what the actual autism evaluation would look like, I am going to describe mine, but it’s slightly different from place to place and from team to team. It probably would also be slightly different with a child, i went through the evaluation process as an adult.

First I had a preliminary interview with a psychiatrist, it was a general discussion of my autistic traits and of the things that made me suspect being autistic. I also showed him my health report and my school report. After that he said he’d recommand me for a full evaluation and he told me to wait for them to contact me. I had the full evaluation two months later. It consisted in:

A full cognitive assessment, they used the WAIS-IV

 A language (and more) assessment, which included a spelling test, a reading speed test, a thing where I had to come up with as many words as I could in two minutes, a theory of mind test, a test in which I had to identify and then imitate intonation, a test in which I had to identify emotions on faces, give definitions or synonyms for words, and maybe more stuff that I can’t remember.

What they called a “functional assessment” which consisted in them asking questions about my daily life, about how I manage activities of daily living, how studying and working is going for me, and so on. I think they had a booklet they took questions from. They also made me do some things like telling the story from a picture and from a picture book, telling a story with objects, playing a kind of pretend game… I was filmed during all of this. They also left the room for a few minutes while leaving me with distractions (a big basket of books and stimmy things), they said they needed to talk but I think they wanted to film how I’d react while alone.

An interview with my girlfriend about my daily life, how I manage activities of daily living and whether I put myself in danger and whether I know how to manage money and stuff. Basically assessing my level of independence I guess.

There was supposed to be an interview with my mom to ask about my early development but she couldn’t come, so they gave her a paper form with questions to answer.

 After that, there is one more appointment with the psychiatrist to give me the results.

That’s about all I can say about diagnosis. The whole process took about a year for me but it’s supposed to be shorter, it would have been if they hadn’t lost my contact information. It didn’t cost me anything. It all took place in my local hospital, in a special evaluation unit for adult autism diagnosis. If you have any more questions I’d be happy to answer them.

Attitudes towards autism in France

First I’d say autism is not as well-known in France as it can be in English-speaking countries. If you ask the general population what autism is, chances are you’ll be met with faint memories of Rain Man and not much else. There’s also a certain awareness of rocking with one’s hands over one’s ears as an autistic thing, and it sometimes is used for ableist jokes and mockery. Mostly, if your character were to try and explain they are autistic to people, they’d probably have to explain everything from the beginning because people don’t really have a working definition of autism.

There’s a lot of ableism towards autism among professionnals, even though most specialists I’ve encountered were well-meaning. Asperger’s is still a very commonly-used diagnostic term here, and chances are your character would have to talk about Asperger’s rather than autism to be understood and taken seriously by professionals. If they don’t have contact with an international community, that’s also probably how they’d identify. All French communities of autistic people I’ve found centered around this word. There are not a lot of these communities, and I’m not aware of any big organization run by and for autistic people. Your character may feel isolated and have trouble finding people like them. Some hospitals or autism centers run discussion groups and meetings for autistic teens, I think.

Regarding autism, things that are well-established in the U.S. are often seen as the Brand Great New thing in France. Basically I think you can say we are about 10 years late in that regard. For instance, I’ve met a lot of professionnals who were excited to work with me because they were very interested in how autism presents in girls, they’ve read there are some differences, and so on. This is not a new researc subject in the U.S., but it is here. Another, less pleasant example of this phenomenon is that here, ABA is seen as the Great New Thing, a new efficient treatment that’s commonly used overseas but barely even known here! We’ve got to train specialists and to develop it! That’s one aspect for which I wish we wouldn’t be making progress.

Most non-specialist mental health and medical professionnals know very little about autism. Once I tried to talk about it to a psychiatrist, and he confused it with schizophrenia and schooled me on why I wasn’t psychotic. I had to teach more than one therapist about it. There are still very backwards “treatments” of autism that are sometimes in use, such as psychoanalysis (on nonverbal 5 year olds...). But as a psychology student I can say we’re mostly getting up-to-date information about autism, so hopefully this should get better in coming years.

As to accomodations, I’ve never had to ask for any so I’m not best placed to answer this question. It is law that people with disabilities (I’m pretty sure you have to have an official diagnosis for this) have to get the accomodations they need in the workplace, in school and in higher education, but I’m not sure how easy it is to get them or how well the laws are respected. I’ve seen a few disabled fellow students who got accomodations, one of whom was autistic (he had someone else take his notes for him and was allowed to record lectures). I can tell you a bit more about how to get accomodations in university; if that’s relevant for you to know you can shoot us another ask once the askbox is open again.

That’s all I can think of off the top of my head, if you have follow-up questions I’d be happy to answer them.

-Mod Cat   

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