Autism Assessment

What is an autism assessment?

Autism assessments are tools that healthcare providers use to diagnose autism spectrum disorder (ASD). The assessments are a key tool for diagnosing ASD during early childhood. But many of these tools can help adults get diagnosed, too.

Experts classify ASD as a developmental disorder because it starts in childhood. Common signs often include:

• Slower social and communication skill development: It can be harder for autistic people to communicate, make friends, form relationships and more.
• Restrictive, repetitive behavior patterns: These can make it harder for autistic people to react to everyday unexpected situations. It can also make change harder to adapt to.

When and why autism assessments happen

Pediatricians in the U.S. typically screen all children for autism during well checks. Pediatricians commonly follow guidelines from two organizations on when to screen. Those are the:

• American Academy of Pediatrics: recommends screening at 18 months and 24 months old
• U.S. National Center on Birth Defects and Developmental Disabilities: recommends screening at 9 months, 18 months, and either 24 months or 30 months old

Research shows early diagnosis and treatment can help children with autism reach their full potential.

Providers may recommend an autism assessment based on:

• What they observe during well-child visits
• Behaviors or symptoms you notice and describe
• School or child care staff describing behaviors or symptoms

Types of autism assessments

Not all autism assessments are the same. Some are simple screening tools that providers use to determine whether a child needs further testing. Others are for making a full diagnosis.

The different assessment tools usually rely on one or more of the following:

• Interviews about yourself or your child, and any symptoms you or your child might experience
• Questionnaires about yourself or your child (depending on who’s being diagnosed)
• Test materials that can highlight differences in communication or processing
• Observation time, where a healthcare provider watches your child do an activity and looks for clues or symptoms

Autism assessment screening and diagnostic tools

Screening tools include:

• Ages and Stages Questionnaire (ASQ®)
• Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (MCHAT-R/F)
• Parents’ Evaluation of Developmental Status (PEDS®)

Full autism assessment tools include:

• Autism Diagnostic Interview-Revised (ADI-R)
• Autism Diagnostic Observation Schedule-2 (ADOS-2)
• Childhood Autism Rating Scale-Second Edition (CARS-2)
• Gilliam Autism Rating Scale-Second Edition (GARS-2)
• Social Communication Questionnaire (SCQ)
• Social Responsiveness Scale-Second Edition (SRS-2)

When a provider is completing an autism assessment, they’ll probably use several of these tools and others.

One reason there are so many different assessment tools is that autism can look very different from person to person. And the tools themselves vary. Some are useful for screening by age. Others are best at uncovering specific symptoms or effects.

Related tests and assessments

Autism has links to many other conditions, so it’s common for providers to test or screen for those, too. Some of the related tests and assessments your child’s provider might recommend include:

• Vision and hearing testing
• Electroencephalogram (EEG) to check for epilepsy if your child has a history of events that could point to seizures
• Brain MRI, if your child’s provider notices differences during a physical exam, like microcephaly
• Genetic testing to make sure that autism isn’t happening because of, or along with, another condition, like fragile X syndrome
• Blood testing for lead poisoning or metabolic diseases

How does an autism assessment work?

Autism assessments work a little differently, depending on the type and the tool used. Some assessments, especially screening tools, take only a few minutes. Your child’s provider may ask you questions or test your child’s reactions to certain things.

Full autism assessments usually take longer. Some can last for a few hours, or they might even take multiple sessions. That’s partly because autism shares many symptoms with other conditions. To diagnose autism, providers also have to rule out other conditions. It’s also because the assessments gather information about how autism affects you or your child specifically. That’s valuable for planning treatments and managing autism’s effects.

What should I expect during an autism assessment?

Autism assessments can have big differences depending on the type of assessment, the specific tool used and more. Because of that, the healthcare provider doing the assessment is the best person to tell you what to expect. They can also tell you what you need to do to prepare.

Screening tests

For childhood screening tests, you usually won’t need to prepare. Your child’s provider can do those during a regular well-child visit. Many of these involve asking you questions about your child or seeing how your child reacts to certain things. Screenings usually take 30 minutes or less.

Diagnostic assessments

Diagnostic autism assessments are more comprehensive. They can take up to several hours. Your provider may recommend doing it over multiple visits. They may also recommend that you prepare for these kinds of visits.

Some things they may suggest when the assessment is for your child include:

• Snacks or other items that can help your child be comfortable during the visit
• Toys that might be useful for the assessment, or that can keep your child occupied or entertained as needed

Your child’s provider can tell you more about what you should or might want to bring.

What to expect after an autism assessment

Your provider can typically tell you the results of an autism screening when they complete it.

Based on that screening, they may tell you the following about your child:

• They don’t show the symptoms of autism right now. Symptoms could still develop later, though.
• They meet some of the criteria. This could mean they have autism, or that they have another condition with similar symptoms. It’ll take more testing to be sure.
• They meet the criteria. They likely have autism and need diagnostic testing. That’ll determine the severity of your child’s case and how it’s affecting them. It’ll also look for any other related conditions and help providers come up with treatment recommendations.

While a provider can make the diagnosis as early as 9 months, most cases don’t get a diagnosis until around age 4. But research still shows that most screening tools for diagnosing autism before age 2 are highly reliable.

When a diagnostic assessment confirms your child is autistic, their provider will also tell you about:

• How severe their case is
• Specific effects, like a language disorder, trouble socializing or sensory overload
• Any other medical conditions related to autism

What are the key signs of autism?

Experts often look for certain telltale symptoms that are autism-specific. Some examples of these include:

• Not babbling, pointing or making other gestures by the time they’re 12 months old
• Not using single words by 16 months old
• Not using two-word sentences by 24 months old (this doesn’t count echoing or repeating what they hear)
• Any loss of language or social skills, no matter what their age

Should I self-diagnose using online assessments or tests?

No, don’t rely on online tests. That includes medically validated ones like the Ritvo Autism Asperger Diagnostic Scale (RAADS) or Autism-Spectrum Quotient (ASQ). There’s no harm in taking these tests, but don’t take them as official confirmation.

A big reason for that is symptom overlap. For example, people with several neurodivergent conditions can score high on these tests. But that’s because of shared symptoms across conditions. Online tests can’t tell you if you have more than one condition. And they can’t tell you if you have a related genetic condition or another health concern.

While online tests aren’t good for diagnosing autism, they can still raise awareness. If taking one of these tests makes you suspect you’re autistic, you may want to talk to your primary care provider about getting diagnosed. They can either screen you for autism themselves or refer you to a specialist for testing.