Autism Assessment
Understanding what a proper autism assessment involves, the diagnostic criteria used, and what to expect from the process.
Autism Spectrum Disorder diagnosis requires meeting criteria in both Domain A (social communication) and Domain B (restricted/repetitive patterns), plus additional requirements about timing and impairment.
Social-emotional reciprocity
- •Difficulty with back-and-forth conversation
- •Reduced sharing of interests or emotions
- •Difficulty initiating or responding to social interactions
Nonverbal communication
- •Difficulty integrating verbal and nonverbal communication
- •Atypical eye contact and body language
- •Difficulties understanding and using gestures
- •Limited or atypical facial expressions
Relationships
- •Difficulty adjusting behaviour to social contexts
- •Difficulty sharing imaginative play or making friends
- •Reduced interest in peers
Must meet ALL 3 criteria
Stereotyped movements, speech, or object use
- •Motor stereotypies (hand flapping, spinning)
- •Echolalia (repeating words/phrases)
- •Idiosyncratic use of phrases
- •Lining up objects
Insistence on sameness
- •Distress at small changes
- •Rigid thinking patterns
- •Greeting rituals
- •Need to take same route
Highly restricted interests
- •Strong attachment to unusual objects
- •Excessively focused interests
- •Perseverative topics of conversation
Sensory reactivity
- •Apparent indifference to pain/temperature
- •Adverse response to specific sounds or textures
- •Excessive smelling or touching of objects
- •Visual fascination with lights or movement
Must meet at least 2 of 4 criteria
Additional diagnostic requirements
Symptoms present in early developmental period
May not fully manifest until social demands exceed capacity, or may be masked.
Symptoms cause clinically significant impairment
In social, occupational, or other important areas of current functioning.
Not better explained by intellectual disability or global developmental delay
Though autism and intellectual disability can co-occur.
Assessment tools
These are the main tools clinicians use. Not all will be used in every assessment.
Gold-standard structured observation. Creates opportunities to observe social communication and play.
Highly trained administrator required. Not a "test" to pass or fail - it's an observation framework.
Detailed structured interview covering developmental history and current functioning.
Takes 2-3 hours. Very thorough but time-intensive.
Computerised structured interview covering autism symptoms and development.
Shorter than ADI-R. Often used in UK services.
Comprehensive interview that also assesses broader difficulties.
Good for complex presentations or when broader profile needed.
Note:
The assessment process
Referral
Initial concerns raised, referral accepted by assessment service.
Service reviews referral information, may request additional details, places on waiting list.
Information gathering
Questionnaires and background information collected.
Parents complete developmental history forms. School provides observations. Medical records reviewed.
Assessment appointment(s)
Direct assessment and interviews with clinician(s).
May be single session or multiple. Includes parent interview, observation/interaction with child.
Multidisciplinary discussion
Team reviews all information (in MDT models).
Different professionals share observations, reach consensus on diagnosis.
Feedback
Results shared with family.
Diagnosis explained, questions answered, next steps discussed.
Report
Written documentation provided.
Detailed report with history, findings, diagnostic conclusions, and recommendations.
Challenging presentations
Some autistic people are harder to diagnose. This doesn't mean they're "less autistic" - it means standard approaches may not capture their experience.
Challenges:
- May camouflage/mask social difficulties
- May have learned social scripts
- Interests may be more typical (though intense)
- Friendship difficulties may be subtle
Approach: Look beyond surface. Ask about effort required. Consider impact of masking.
Challenges:
- May compensate with intelligence
- Difficulties may emerge later (secondary school)
- May be dismissed as "quirky but fine"
- Often delayed diagnosis
Approach: Compare to cognitive peers. Look for hidden struggles. Consider internal experience.
Challenges:
- ADHD can mask autism features
- Social difficulties attributed to impulsivity
- Hyperactivity can obscure repetitive behaviours
- Shared features complicate assessment
Approach: Assess both thoroughly. Consider staged assessment.
Challenges:
- Autism features may be attributed to language delay
- Communication difficulties affect assessment
- May need adapted assessment approaches
Approach: Use appropriate tools. Focus on nonverbal communication. Involve speech therapy.
Autism assessment is clinical judgement, not a test. There's no blood test or brain scan for autism. Diagnosis is made by trained clinicians integrating information from multiple sources to form a clinical opinion.
A good assessment considers not just whether criteria are met, but how autism presents in your specific child, what support they need, and what their strengths are.