Assessment - Guidelines

Guidelines for assessing autistic traits and skills in children and youth

Screen for early identifying traits of autism. Autism can be reliably diagnosed in the second year of life and earlier diagnosis has been found to be related to better outcomes later in life.

Use both developmental history and information about current functioning to detect autism. DSM-5 requires that an individual meets each criterion of diagnosis currently and/or by history.

Gather information about current functioning by direct observation and interaction with the individual being evaluated. DSM-5 does not specify diagnostic criteria but instead specifies diagnostic principles that need to be exemplified through clinician and family generated reports and observation.

Integrate information from a variety of sources such as interviews, questionnaires and systematic standardized observations. Since autistic individuals might display different behaviors in different settings and with different people, it is essential that data be obtained from various settings such as clinic, home, day-care, school, place of work if applicable. This is especially important when insufficient data on an individual might lead to a missed diagnosis resulting in denial of access to services.

Conduct a comprehensive evaluation of an individual's functioning, including their strengths and challenges in intellectual functioning, communicative functioning and adaptive functioning. In addition to the two diagnostic domains in DSM criteria for autism, assessments in these areas can be useful in the following ways:

Some individuals who met diagnostic criteria in the past but have since learned to mask their autistic traits may still be eligible for services if an assessment of their adaptive functioning reveals a need for support.
A complete neuropsychological assessment of cognitive functions may reveal both strengths and weaknesses in cognitive processing in the individual. This can provide a more complete picture of the often-uneven development of skills in autistic individuals and might lead to the design of better supports that leverage their strengths to bolster their areas of weakness.
An in-depth assessment of communicative functioning (beyond social communication that is part of the diagnostic criteria) is useful since language development has been shown to be correlated with later life outcomes in this population. Such assessment can guide any needed intervention in this area to improve outcomes in the lives of these individuals.

Use assessment tools that provide a reliable and valid measurement of traits related to autism that clinicians can use make an informed diagnosis. Clinicians should be aware of the psychometric properties of the tools in order to accurately interpret results within and across instruments.

Select assessment tools that provide a fair measurement of traits for a particular individual based on their age, developmental level, culture and language abilities. For example:

Formal, norm-referenced assessment tools that often require verbal responses, motor movements and/or timed responses may not be suitable to evaluate the communicative capabilities of non-verbal autistic children. Criterion-referenced assessments that assess an individual child's ability to use communication strategies or tools, and observation of natural communicative interactions between the child and their caregivers may provide a more useful measurement of their abilities.
Consider an individual’s chronological and mental ages when choosing and administering an IQ test. For children with significant developmental delays, using a test suitable for a wide age range might avoid floor effects and provide a more meaningful interpretation of the score obtained.

Administer assessments in a way that ensures the intended construct is being measured and not the ability to comply, imitate or socialize with the evaluator. Flexibility in assessment might be particularly important when assessing infants and toddlers who may have limited capacity to sit at or stand near the assessment table, comply with adult directives, or benefit from modeling and instruction of tasks. It is also important to ensure that the individual being assessed is engaged and motivated to perform to their capacity during the tests.