Approaching a supervisor regarding competence and discomfort

[bookwormpsych]

Hi all. I'm having a bit of an issue with a supervisor over psychological testing and what I can and can't/won't do. I am looking for guidance or tips on how to navigate professional boundaries. If asking for this kind of guidance is appropriate on this board, please let me know.

So, bit of back story. I do psychological testing for 2 psychologists at a practice in my town. I usually do WISC, WAIS, WRAT, WIAT, NEPSY, WMS, RBANS, MMPI, PAI, etc... a whole variety, depending on what they come in for of course. Well, this practice also does a lot of Autism testing, which I have made absolutely clear that I am not competent in so those cases usually go to an intern who is trained in the ADOS. One of my supervisors is totally accepting and understanding of the fact that is something I am not trained in.

The other supervisor, however, has had me attend a "training" (it was a formal training, however, he scheduled me over the training and I only caught the last 15 minutes of it...). He has had me observe a total of 2 whole ADOSs, and believes that I am "trained" enough to be administering and scoring it. I have told him multiple times, no, that I am not comfortable with it, I am not competent in this, and it goes against APA standards and my state's regulatory standards/ethics to do something you're not competent in. I also mentioned that it is crossing a professional boundary and he laughed it off. He also won't provide formal training, and just keeps telling me to read the manual (which I have done), but this is a big thing (to me) and I don't feel that this "training" has been enough - but that isn't the point.

Well, not next week (I alternate weeks between which psychologist I work for) but the week after, he has two ADOS clients on my schedule. I'm trying to navigate how to professionally say, "hey, no, I won't do it." My fear is that he'll say, "I pay you to do testing, do as I say" or something of that sort. I know that testing is my job, but me not doing ADOSs has never been an issue until recently, as he has blatantly ignored my set boundaries.

Also, we all have our "areas" of things we are good at/not good at, and things we want to do/don't want to do. I'm comfortable with literally anything else, any other tests we do, except the ADOS. We even have 2 people on staff that are adequately trained and can do them, why try and have me do something that they can do? To note, as well, it may seem that I'm throwing a fit but I know what I'm competent in and this is not it, and my other supervisor respects this completely and has me do things he knows I'm good at.

Also, not sure if important, but the interns are not licensed and work under the supervisors license. So if they mess up and do things they don't know how to do, cool, that's his problem. But me, I'm licensed and am working under my own license and am not willing to go against ethical standards to do something to make him happy.

---

Members don't see this ad.

 

[AcronymAllergy]

Just to clarify, is this a formal training opportunity through your graduate program (e.g., practicum), or are you an employee?

 

[borne_before]

Just spoil a couple of ADOS-2's and he'll learn real quick. JK Don't do that. That's such a neuropsych thing lol. Here's a training and now you're good to go.

 

[DrSoon2016]

Thank you for your honesty and for considering ethics when it comes to testing.jt sounds like you are very confidently saying that you are not comfortable with administering the test. I think you should stick to your gut and only administer it if it can be monitored by the supervisor or done together. If he objects, well then he will have to find someone else to administer it.
I know I would never want my child given the ados by someone who is not fully comfortable or trained. I’m concerned to hear that you have voiced your feelings repeatedly and your supervisor is not taking it seriously. I’m sorry that you’re experiencing this but I respect that you are reflecting on what you feel you can and can’t do ethically

 

[bookwormpsych]

Just to clarify, is this a formal training opportunity through your graduate program (e.g., practicum), or are you an employee?

I am an employee. I've never been trained on the ADOS through my grad program (prior to graduation), or during my time here as an employee, other than "training" mentioned above.

 

[bookwormpsych]

Just spoil a couple of ADOS-2's and he'll learn real quick. JK Don't do that. That's such a neuropsych thing lol. Here's a training and now you're good to go.

You know what makes it even worse, that I forgot to mention? After observing the 2 ADOS for my "training," he made me do one, after telling him my discomfort and all that. It was an absolute train wreck, the parents had asked me if I even knew what I was doing and made a complaint to our HR about "untrained staff" due to it. After making my case, HR didn't penalize me but still.

On some assessments, like a Wechsler scale, after observing a couple of times and some supervisor I feel very comfortable doing those, they're all basically the same with their own rules and what not. But I have NEVER been trained in autism anything and doing the ADOS is way out of my league, and he isn't hearing it.

 

[bookwormpsych]

Thank you for your honesty and for considering ethics when it comes to testing.jt sounds like you are very confidently saying that you are not comfortable with administering the test. I think you should stick to your gut and only administer it if it can be monitored by the supervisor or done together. If he objects, well then he will have to find someone else to administer it.
I know I would never want my child given the ados by someone who is not fully comfortable or trained. I’m concerned to hear that you have voiced your feelings repeatedly and your supervisor is not taking it seriously. I’m sorry that you’re experiencing this but I respect that you are reflecting on what you feel you can and can’t do ethically

Thank you. I'm just so newly licensed, I don't want to do things to jeopardize my hard work to get this far. I also, ethically, do not want to be messing with people's kids when I don't know what I'm doing! As you mentioned, I wouldn't want someone who's not trained or clearly uncomfortable testing my child either. I've brought this up more than a few times and he hears me, but doesn't hear me.

 

[AcronymAllergy]

Quick response: I think you are 100% correct and justified in sticking to your guns that you do not feel adequately trained and competent to perform the assessments. It'd potentially be one thing if you were (as you've said) an intern or other trainee working under your supervisor's license. But you're working under your own license, and it's ultimately up to you to determine, within the legal scope of your license, what you do and do not feel competent doing.

Was there any type of employment contract that stipulates specifically what your work entails, your duties are, etc.?

 

[StellaB]

Thank you. I'm just so newly licensed, I don't want to do things to jeopardize my hard work to get this far. I also, ethically, do not want to be messing with people's kids when I don't know what I'm doing! As you mentioned, I wouldn't want someone who's not trained or clearly uncomfortable testing my child either. I've brought this up more than a few times and he hears me, but doesn't hear me.

As someone who is trained in the ADOS, I just want to say that your gut on this is absolutely correct. As you have seen from doing it, it's not a standardized test that you can just learn quickly if you already know the WAIS/WISC. It is more like a structured clinical judgment measure with activities designed to bring about myriad specific behavioral observations that the evaluator is trained to watch for. If you have no experience with autism, it's not something you can just jump into. That said, the best way to administer it is with two clinicians (one engaging with the client, one writing observations), and you could potentially learn over time if there is always a second person with appropriate training and experience who is in the room observing everything and then you score it together. Even still, you would want to do a full ADOS training though.

 

[borne_before]

I hate the ADOS-2*.

*I still give it like three times a week.

 

[bookwormpsych]

Well guys, here is an update. I talked to my supervisor.

He was extremely rude, arrogant, and all around an a**. I laid out my discomfort, told him I won't do the two ADOSs scheduled for me next week due to my incompetence and discomfort, and he told me.....

It's not a matter of "competence" I've been "trained" (watching two... stumbling through one... as if Autism testing is straight forward...), that I am "refusing to do my job" and "being disrespectful." I explained that this is my license that I am protecting, as I am not an intern, and that it isn't true that I am just "refusing." I am incompetent in this area, it's way outside of my scope, and I DON'T KNOW HOW TO DO IT. He told me he is going to discuss this with my other supervisor, and that he wants to let me go.

Fine, so be it, not entirely sure I want to work for someone like this anyhow. My other supervisor will have my back.

Also, @AcronymAllergy , there was no laid out "contract" for this job. Just a general agreement between professionals that I am hired to administer psychological testing to my appointments for X amount of $ per hour, for 40 hours per week. That's it. Which, is fine with me. No stipulations about what tests I have to/don't have to give. I give everything asked of me, except this.

 

[AcronymAllergy]

That's exceedingly unfortunately for your supervisor to respond that way, although it doesn't sound like it was unexpected, given what you've said about him. If ultimately you are let go, you may have dodged a bullet. If not, the supervisor in question will hopefully do a better job of appreciating your professional/competence boundaries, and now the other supervisor is more aware as well. Good on you for protecting your license and, more importantly, the patients/families.

At the end of the day, if the practice sees a significant/increasing portion of its referrals and income via ASD evaluations, it may just be a poor fit (if it's not something you're ever looking to get into) or they need to provide adequate training.

 

[summerbabe]

I explained that this is my license that I am protecting, as I am not an intern, and that it isn't true that I am just "refusing." I am incompetent in this area, it's way outside of my scope, and I DON'T KNOW HOW TO DO IT. He told me he is going to discuss this with my other supervisor, and that he wants to let me go.

Sorry you’re going through this but you are 100% in the right and he is 100% an ass. I certainly would not want to refer to somebody more focused on $$$ and quantity than providing actual care.

I hope this doesn’t impact your income (even if moving on might end up being the best fit) and the other partner in this business is more patient driven than him. Good luck!

 

[bookwormpsych]

That's exceedingly unfortunately for your supervisor to respond that way, although it doesn't sound like it was unexpected, given what you've said about him. If ultimately you are let go, you may have dodged a bullet. If not, the supervisor in question will hopefully do a better job of appreciating your professional/competence boundaries, and now the other supervisor is more aware as well. Good on you for protecting your license and, more importantly, the patients/families.

At the end of the day, if the practice sees a significant/increasing portion of its referrals and income via ASD evaluations, it may just be a poor fit (if it's not something you're ever looking to get into) or they need to provide adequate training.

Sorry you’re going through this but you are 100% in the right and he is 100% an ass. I certainly would not want to refer to somebody more focused on $$$ and quantity than providing actual care.

I hope this doesn’t impact your income (even if moving on might end up being the best fit) and the other partner in this business is more patient driven than him. Good luck!

Thank you both for your responses. This is such an odd thing to navigate. I was taught in my grad program to be vocal about your own shortcomings, boundaries, and competence. So, I think I did the right thing. I love this job dearly and I am just thankful that at least 1/2 of my supervisors understands.

Oddly, most of the referrals are for just general testing - WISC, academic, ADHD, etc., but this particular supervisor adds ASD testing to nearly every kid. My other supervisor gets mainly adult referrals for just general testing, or older adult memory/cognitive/neuro testing. They have their own "things." So, I hope it never becomes a conflict with poor fit as I love this job, just not a huge fan of this treatment -- for me, and for our patients.

I appreciate all responses from everyone and as this is unfortunate to go through, I at least know I did what is best for me and patients. I'm thankful for the insight and support from everyone here.

 

[WisNeuro]

Thank you both for your responses. This is such an odd thing to navigate. I was taught in my grad program to be vocal about your own shortcomings, boundaries, and competence. So, I think I did the right thing. I love this job dearly and I am just thankful that at least 1/2 of my supervisors understands.

Oddly, most of the referrals are for just general testing - WISC, academic, ADHD, etc., but this particular supervisor adds ASD testing to nearly every kid. My other supervisor gets mainly adult referrals for just general testing, or older adult memory/cognitive/neuro testing. They have their own "things." So, I hope it never becomes a conflict with poor fit as I love this job, just not a huge fan of this treatment -- for me, and for our patients.

I appreciate all responses from everyone and as this is unfortunate to go through, I at least know I did what is best for me and patients. I'm thankful for the insight and support from everyone here.

This seems problemmatic. Sort of "padding" the billing to give out an ADOS to most kids. If anything, they need to be screening in some way, and only adding the ADOS if the screening indicates it is useful. Over-testing is unfortunately, something of a problem in our field. Like hacks that say they need six hours of testing to evaluate a generic dementia case.

 

[StellaB]

I cannot imagine having a legitimate concern about autism on "nearly every kid" that comes in for evaluation...

 

[WisNeuro]

I cannot imagine having a legitimate concern about autism on "nearly every kid" that comes in for evaluation...

Well, yes, and no. I mean, I have a legitimate concern that almost every 65+ year old may have dementia in my clinical cases. Because that's what they are coming in for. In the OPs case, there is likely wider range of concerns in that particular population. So, presumably, they are likely seeing a higher proportion of kids with ASD than the general population base rate as kids functioning fine are generally not those that are presenting. That being said, you still screen for things first before dedicating a multi-hour assessment aimed at a specific diagnosis. This isn't like some other instruments that are useful in helping to delineate any number of things, it's fairly specific.

 

[borne_before]

I cannot imagine having a legitimate concern about autism on "nearly every kid" that comes in for evaluation...

I just saw a nurse practitioner for ADHD meds after my lovely one retired. She thinks I have asd and ocd… lol. She also said her kids have asd…

Good thing my meds are figured out and they’re easy to get into or else I’d find someone else. I think we may be approaching peak autism. I hope so. We’re quickly approaching that diagnosis having no meaning.

 

[WisNeuro]

I just saw a nurse practitioner for ADHD meds after my lovely one retired. She thinks I have asd and ocd… lol. She also said her kids have asd…

Good thing my meds are figured out and they’re easy to get into or else I’d find someone else. I think we may be approaching peak autism. I hope so. We’re quickly approaching that diagnosis having no meaning.

Honestly, with NPs, it may be more diagnostic incompetence than peak autism. I have not been impressed with the diagnostic abilities of most psych NPs that I've directly worked with.

 

[foreverbull]

Well guys, here is an update. I talked to my supervisor.

He was extremely rude, arrogant, and all around an a**. I laid out my discomfort, told him I won't do the two ADOSs scheduled for me next week due to my incompetence and discomfort, and he told me.....

It's not a matter of "competence" I've been "trained" (watching two... stumbling through one... as if Autism testing is straight forward...), that I am "refusing to do my job" and "being disrespectful." I explained that this is my license that I am protecting, as I am not an intern, and that it isn't true that I am just "refusing." I am incompetent in this area, it's way outside of my scope, and I DON'T KNOW HOW TO DO IT. He told me he is going to discuss this with my other supervisor, and that he wants to let me go.

Fine, so be it, not entirely sure I want to work for someone like this anyhow. My other supervisor will have my back.

Also, @AcronymAllergy , there was no laid out "contract" for this job. Just a general agreement between professionals that I am hired to administer psychological testing to my appointments for X amount of $ per hour, for 40 hours per week. That's it. Which, is fine with me. No stipulations about what tests I have to/don't have to give. I give everything asked of me, except this.

It's good that you held that boundary, although I'm sorry to hear that it didn't go well. You are a licensed clinician, so I think you hold a fair amount of power here in saying no. It doesn't sound like the duties of your assessments were laid out specifically in your contract, so there was no explicit agreement that you have to administer the ADOS as part of your battery.

Also, side note, this is something that will be easy to explain to future employers. Competence is competence; it's completely unreasonable to demand that you perform outside of your skills/competence. In fact, from what you've said, it sounds like your supervisor pushed for unethical practice by scheduling those ADOS assessments without you having proper training or feeling competent to administer them.

Good for you!

 

[BuckeyeLove]

This dude is a basic business bro, not a psychologist. Run far far away.

 

[erg923]

Are you licensed as the doctoral level? Why are these other psychologist dictating your testing battery?

 

[StellaB]

Well, yes, and no. I mean, I have a legitimate concern that almost every 65+ year old may have dementia in my clinical cases. Because that's what they are coming in for. In the OPs case, there is likely wider range of concerns in that particular population. So, presumably, they are likely seeing a higher proportion of kids with ASD than the general population base rate as kids functioning fine are generally not those that are presenting. That being said, you still screen for things first before dedicating a multi-hour assessment aimed at a specific diagnosis. This isn't like some other instruments that are useful in helping to delineate any number of things, it's fairly specific.

I mean, autism assessment is something I semi-specialize in with my private practice, and even then it’s not coming close to every child getting an ADOS. Kids get assessed for all kinds of things. Isn’t it something like 8% of US adults over 65 have dementia? The rate of autism in the US is under 2%. So throwing an ADOS (takes an hour to administer, gold standard method = two clinicians, so 2 hours of billing) onto almost every case? That’s excessive.

 

[bookwormpsych]

This seems problemmatic. Sort of "padding" the billing to give out an ADOS to most kids. If anything, they need to be screening in some way, and only adding the ADOS if the screening indicates it is useful. Over-testing is unfortunately, something of a problem in our field. Like hacks that say they need six hours of testing to evaluate a generic dementia case.

Thank you for putting this into words. This is exactly what he is doing. It's all $$$ and no concern for actual diagnoses. He over diagnosis ASD, ADHD, all of 'em.... to all the kids.

This dude is a basic business bro, not a psychologist. Run far far away.

I'm starting to feel this way. I've only been here since mid- April. Well, since September but that was once a week and now I've been FT since April and am seeing this...

Are you licensed as the doctoral level? Why are these other psychologist dictating your testing battery?

Unfortunately, no. I'm a master's level LPA. They do the initials, dictate the batteries, write the reports, give the results. I literally just administer and score. My other supervisor (the one that isn't "bad" lets me dictate some of the testing in terms of knocking off or adding on things I think necessary/unnecessary as he trusts my judgment, for the most part). Also, my "good" supervisor provides me with supervision lunches, so I actually learn from him which is nice.

 

[WisNeuro]

I mean, autism assessment is something I semi-specialize in with my private practice, and even then it’s not coming close to every child getting an ADOS. Kids get assessed for all kinds of things. Isn’t it something like 8% of US adults over 65 have dementia? The rate of autism in the US is under 2%. So throwing an ADOS (takes an hour to administer, gold standard method = two clinicians, so 2 hours of billing) onto almost every case? That’s excessive.

I'll rephrase, as I think my point was lost a little. I was more commenting that base rates in clinics are generally much higher than base rates in the population, in part because people who do not have these diagnoses or cognitive/psychiatric concerns, are far less likely to seek care. So, I'd still expect actual diagnoses in said clinic far above 2%. But, we are both in agreement that the full ADOS for every battery is gross incompetence in such a clinic. I'm generally of the opinion that fixed batteries are nonsense and most clinicians using them clinically are incompetent or were trained like 40 years ago. Assessment experts should be able to tailor an effective, and efficient, battery for the case in front of them.

 

[DrSoon2016]

Is this something that’s possibly reportable to the boards?If you have expressed concerns that clinicians are administering protocols Without proper training and even after voicing concerns. I’m not saying to report or not report, I’m just wondering what others think about this. Seems like his practice is extremely unethical. I’m sorry you had to go through this, I wish you all the best moving forward. It does sound like you dodged a bullet.

 

[futureapppsy2]

I cannot imagine having a legitimate concern about autism on "nearly every kid" that comes in for evaluation...

True, but according to the internet--and much to my chagrin--literally *anything* can be a symptom of ADHD/ASD/CPTSD, sigh.

OP, I agree that this is very concerning and unfortunate. Once you have your next position lined up, you might consider notifying the psychology licensing board.

 

[robellis]

I just saw a nurse practitioner for ADHD meds after my lovely one retired. She thinks I have asd and ocd… lol. She also said her kids have asd…

Good thing my meds are figured out and they’re easy to get into or else I’d find someone else. I think we may be approaching peak autism. I hope so. We’re quickly approaching that diagnosis having no meaning.

Why are you seeing an NP instead of a doctor?

 

[thebalmofhurtminds]

Why are you seeing an NP instead of a doctor?

Not the original poster, but no choice in my city, unless you'd like to wait over a year for an appointment.

 

[WisNeuro]

Also, if it's just for someone to refill longstanding meds, meh.

 

[Shiori]

Yeah, we have a NP who does that at our VA and she is great. The psychiatrists love having her too. She is a nice bridge between the PCPs and psychiatrists.

 

[borne_before]

Why are you seeing an NP instead of a doctor?

A few reasons, but I actually like NPs better! I have pretty simple case of good ole fashioned ADHD, so I just need a stimulant and I've been on the same one for a long time now (I'm actually taking my dose lower and lower). I first saw a psychiatrist back in the day to help me figure it out.

Like I said, I saw an NP for like the last 4 years before she retired. My clinic also has two NPs. One is, without a doubt, the best prescribing clinician I've ever met, in terms of her knowledge and bed side manner. The other is a recent graduate and little underhanded with the stimulants for patients with ADHD but patients love her. And lets be honest (and evidence based), like 90% of ADHD treatment is finding the right med, and for most people all they need is some form of mph or amphetamine. So she's a little guanfacine biased in her prescribing.

I hear wonderful things about the NPs from patients who have been burned by psychiatrists. In my experience, psychiatrists are often the bottom of the MD barrel...

In my state NPs are independent providers.

This new one I saw kind of bugs me. But, my med situation is pretty figured out. I think she spends to much time online in ASD/ADHD communities and can be a little woo-y because of that. I feel a little bit like Ron Swanson at home depot.

But yeah, I really like NPs. I wanted to a psychiatrist, but during my internship year, I tried strattera, and guess what, I was messing some stuff up. So an NP was able to get me quicker and quickly changed my bias.

 

[clausewitz2]

I just saw a nurse practitioner for ADHD meds after my lovely one retired. She thinks I have asd and ocd… lol. She also said her kids have asd…

Good thing my meds are figured out and they’re easy to get into or else I’d find someone else. I think we may be approaching peak autism. I hope so. We’re quickly approaching that diagnosis having no meaning.

A couple years back I saw a young woman in a PES/ED type setting who reported that she had ASD. She was almost legally an adult and said she had been diagnosed very recently. When I asked her what led to that, she said it was because she sometimes had trouble sleeping. She also once kissed a boy her parents disapproved of. Therefore she was autistic. Because she was autistic, she told me, she had a service dog. She had brought it with her to the ED. She did not really have an answer when asked what it was trained to do, apart from cuddle sometimes. To be clear, she had been accepted into a competitive university, so this was not an issue of intellectual disability. Very bourgie, attended a fancy private school. Had plenty of friends, wide-ranging interests, pragmatics totally unremarkable.

The dog was of course an enormous German Shepherd in a vest clearly bought off Etsy. She was much less interested in psych hospitalization when she was told she could not actually bring it with her onto the unit.

Thankfully the child was actually mostly fine (or would be when she wasn't in the same home as one of her parents, I suspect), but I have yet to see a stupider ASD diagnosis in the wild.

 

[ClinicalABA]

I cannot imagine having a legitimate concern about autism on "nearly every kid" that comes in for evaluation...

I do, but that's basically the only reason kids are referred to me!

 

[cara susanna]

If you read social media, pretty much everything is a symptom of autism.

 

[ClinicalABA]

We do primarily ASD testing in our clinics. It's very rare that we have an intern come to us with previous ADOS-2 experience. Our practica students/interns will typically observe us administering the ADOS-2 for about 2 months or so (2-4 administration per week). After a few weeks, we'll have them observe and independently score our administrations, with immediate review and feedback after the testing. Next step is some joint administrations, with the psychologist gradually fading out as necessary, but always present. Once the student demonstrates proficiency (and interrater reliability), they will administer the entire test, but with us still present. If then determined to be independently competent, and they have appropriate credentials, we may then have them do some independent administration, billing under a tech code (this is more likely the case with postdocs than practica students). We do have them start doing the write-ups pretty early on though.

With the ADOS-2 (maybe moreso than any of the more structured kiddo stuff we do, such as cog and language testing), I find that the "session management" stuff can be more difficult to pick up on than the technical admin stuff. This is particularly true for the Toddler Mod and Mod 1 (there is slightly more nuance and technical decision making in Mod 2 and beyond). Things like maintaining and directing a child's attention to the testing task (or even room!), kindly directing caregivers not to answer for or direct the child, and- most importantly- keeping track of and managing the bins full of crap materials that are involved.

I don't know that, as whole, it's a more complicated test than something like a Bayley-III or PLS-5, it's just a little different from what most psych students are typically trained on, given it's criterion-based nature and lack of a tight administration structure.

 

[AcronymAllergy]

We do primarily ASD testing in our clinics. It's very rare that we have an intern come to us with previous ADOS-2 experience. Our practica students/interns will typically observe us administering the ADOS-2 for about 2 months or so (2-4 administration per week). After a few weeks, we'll have them observe and independently score our administrations, with immediate review and feedback after the testing. Next step is some joint administrations, with the psychologist gradually fading out as necessary, but always present. Once the student demonstrates proficiency (and interrater reliability), they will administer the entire test, but with us still present. If then determined to be independently competent, and they have appropriate credentials, we may then have them do some independent administration, billing under a tech code (this is more likely the case with postdocs than practica students). We do have them start doing the write-ups pretty early on though.

With the ADOS-2 (maybe moreso than any of the more structured kiddo stuff we do, such as cog and language testing), I find that the "session management" stuff can be more difficult to pick up on than the technical admin stuff. This is particularly true for the Toddler Mod and Mod 1 (there is slightly more nuance and technical decision making in Mod 2 and beyond). Things like maintaining and directing a child's attention to the testing task (or even room!), kindly directing caregivers not to answer for or direct the child, and- most importantly- keeping track of and managing the bins full of crap materials that are involved.

I don't know that, as whole, it's a more complicated test than something like a Bayley-III or PLS-5, it's just a little different from what most psych students are typically trained on, given it's criterion-based nature and lack of a tight administration structure.

This sounds like an excellent training setup, and seems to be lightyears beyond what the OP's supervisor provided.

Heck, I wouldn't be comfortable with an intern independently administering the more-structured cognitive instruments I typically use (let alone an ADOS-2) if they'd never given them previously, had only observed me twice, and had experienced some growing pains with their first administration. I'll usually observe at least the first handful of evaluations and provide direct feedback afterward, and this with interns who typically have some degree of cognitive testing experience.

 

[borne_before]

I will add, that I don't hate the ADOS-2 per se, but I hate setting it up and then cleaning everything.

 

[futureapppsy2]

If you read social media, pretty much everything is a symptom of autism.

Or CPTSD....

 

[bookwormpsych]

We do primarily ASD testing in our clinics. It's very rare that we have an intern come to us with previous ADOS-2 experience. Our practica students/interns will typically observe us administering the ADOS-2 for about 2 months or so (2-4 administration per week). After a few weeks, we'll have them observe and independently score our administrations, with immediate review and feedback after the testing. Next step is some joint administrations, with the psychologist gradually fading out as necessary, but always present. Once the student demonstrates proficiency (and interrater reliability), they will administer the entire test, but with us still present. If then determined to be independently competent, and they have appropriate credentials, we may then have them do some independent administration, billing under a tech code (this is more likely the case with postdocs than practica students). We do have them start doing the write-ups pretty early on though.

With the ADOS-2 (maybe moreso than any of the more structured kiddo stuff we do, such as cog and language testing), I find that the "session management" stuff can be more difficult to pick up on than the technical admin stuff. This is particularly true for the Toddler Mod and Mod 1 (there is slightly more nuance and technical decision making in Mod 2 and beyond). Things like maintaining and directing a child's attention to the testing task (or even room!), kindly directing caregivers not to answer for or direct the child, and- most importantly- keeping track of and managing the bins full of crap materials that are involved.

I don't know that, as whole, it's a more complicated test than something like a Bayley-III or PLS-5, it's just a little different from what most psych students are typically trained on, given it's criterion-based nature and lack of a tight administration structure.

That sounds like an amazing set up for trainees. And wayyyyyyyyy beyond what my supervisor provided. Also, to note - the ones I observed weren’t done by my supervisor himself (I’m honestly not sure he is even trained in them… he won’t see kids himself, he makes all the psychometricians or interns test the children…), they were done by an intern. Her “training” included watching the ADOS2 videos, reading the manual, and observing like 5… so not even sure she should be teaching it????

Either way - supervisor #2 (the GOOD one) is taking me on full time, I put in my two weeks notice for the supervisor giving me troubles, and I’m looking at board notification because what he does as a whole is clearly unethical. He gave me a probationary letter stating that if I don’t learn it (on my own, similar to how the intern mentioned above was “trained”) that I was to be released from my job. I didn’t sign the letter and simply turned in my notice. Not going to do this crap. This is my license and I won’t risk the harm to it, or kiddos, over this battle.

 

[ClinicalABA]

I will add, that I don't hate the ADOS-2 per se, but I hate setting it up and then cleaning everything.

I was literally in the process of cleaning ADOS-2 stuff when I saw this post!