Autism Assessments, what is happening here?
When you first hear a professional discuss the possibility of an autism diagnosis, it can be overwhelming. All the questions related to supporting yourself, your child, or a loved ones can come crashing into your mind.
I wanted to take a few moments and talk about assessments. Assessments are the key to many supports for neurodivergent individuals, so I wanted to take some time and discuss a few that I am aware of. This is by no means an exhaustive list but perhaps this can give you a place to start.
Before we get to the specific assessments, we will start with what the assessments are looking for anyways. In general, the assessments of autism are observing three domains, social engagement (how you make and maintain relationships), emotion regulation (understanding emotions and managing them), restrictive behaviors (verbal and physical stims, insistence on “sameness” etc.) and communication skills (how you engage with others). If there are enough support needs in these categories, a person may qualify for a diagnosis of autism.
Now we will start with the self-reporting questionnaires, those that you can find online or that a professional will send home and ask you to complete.
First on the list is the RAADS, “(Ritvo Autism Asperger Diagnostic Scale) is a widely used, 80-question self-report questionnaire designed to help identify autism spectrum disorder (ASD) in adults (ages 16 and older) of normal intelligence. It is particularly effective for catching subtle or masked autistic traits.” This assessment is not considered diagnostic on its own however it can accessed online without a professional providing it and can be an informative place to start for older teens and adults who are curious if an autism diagnosis will fit for them.
The next self-reporting questionnaire to mention is the CAST, “The Childhood Autism Spectrum Test (CAST)—formerly the Childhood Asperger Syndrome Test—is a questionnaire designed to screen for autism-related traits in children aged 4 to 11. Developed by the Autism Research Centre at the University of Cambridge, it serves as a preliminary tool to identify if a child requires a comprehensive evaluation.” This report is one that I personally use and recommend families start with, it can be accessed online without professionals providing it and can give a glimpse into where autism is diagnostic or not.
One to mentions is the GADS, “the Gilliam Asperger's Disorder Scale (GADS) is a standardized, norm-referenced behavioral assessment tool designed by Dr. James E. Gilliam to evaluate individuals (ages 3–22) who display characteristics of Asperger's Disorder or high-functioning autism. The assessment relies on frequency-based ratings (from "never observed" to "frequently observed") provided by parents, teachers, or professionals who know the subject well.” This self-report form is often provided by professionals and is considered, this form was widely used for a time and although it does remain relevant and informative, it does not fit the more contemporary standards for diagnosis autism.
Finally, “The Gilliam Autism Rating Scale, Third Edition (GARS-3) is one of the most widely used norm-referenced screening tools in the world designed to help clinicians, teachers, and parents identify Autism Spectrum Disorder (ASD) and estimate its severity. Unlike the older GADS, the GARS-3 is fully aligned with the diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).” This is another assessment that needs to be provided and scored by a professional.
The self-reporting questionnaires are a great place to start if you or a professional working with you or your child suspects autism, however, when attempting to seek services specifically catered towards autistic needs many insurance companies and organizations will want interviews/assessments that are conducted by a professional.
The first to mention is called the ADI-R “The Autism Diagnostic Interview- Revised (ADI-R) is an extensive interview with the parent or caregiver that helps the clinician obtain detailed information that is important in the diagnosis of autism spectrum disorders (ASD). The interview lasts 1½ to 2½ hours and can be completed for individuals age two years and older.
The questions on this highly structured interview focus on three categories that are relevant to ASD: language and communication, social interactions and repetitive, restricted behaviors.
The scores on the ADI-R, based on the answers to the questions, indicate whether or not an individual’s behaviors are consistent with ASD.”
This interview I offer in my practice on a case-by-case basis, where it may fall short is the lack of observation, since the interview is conducted with the caregiver/parent ONLY and the child is not directly observed. Where it can help are in those cases where you are on waitlist for an observation-based assessment and you would like some form of information to get started and it may also be useful when considering school support as it provides scores that can be used to clarify needs. If you are interested in this please contact me and we can see if this is something that could support your child.
The next that has crossed my path is call the “MIGDAS-2 (Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition) is a qualitative, sensory-based diagnostic interview framework designed to evaluate autism spectrum brain styles across the lifespan. Developed by Dr. Marilyn J. Monteiro, it is highly regarded as a neurodiversity-affirming assessment tool. Unlike standardized rating scales (like the GARS-3) that generate a comparative numerical score, the MIGDAS-2 focuses on gathering rich, qualitative data to build an individualized behavioral profile. “ The MIGDAS-2 can be used to help identify autism and is regarded as one of the standards to use.
Then finally, the ADOS, “Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is a semi-structured, standardized assessment tool considered the global "gold standard" for diagnosing Autism Spectrum Disorder (ASD). Developed by Dr. Catherine Lord and colleagues, it relies on direct observation of an individual's social communication, interaction, and repetitive behaviors within a clinical setting.”
If you have ever been referred to an autism assessment, odds are it was for the ADOS.
This post why by no means an exhaustive explanation of the assessments offered for autism but hopefully it is a place to start as you learn new terms and seek supports.
Sources
Part 1: Self-Reporting & Screening Instruments
RAADS-R (Ritvo Autism Asperger Diagnostic Scale-Revised)
Academic Paper: Ritvo, R. A., Ritvo, E. R., Guthrie, D., Ritvo, M. J., Hufnagel, D. H., McMahon, W., Tonge, B., Nicolson, R., & Freeman, B. J. (2011). The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R): A scale to assist the diagnosis of Autism Spectrum Disorder in adults: An international validation study. Journal of Autism and Developmental Disorders, 41(8), 1076–1089. National Institutes of Health Portal.
CAST (Childhood Autism Spectrum Test)
Academic Paper: Williams, J., Scott, F., Stott, C., Allison, C., Bolton, P., Baron-Cohen, S., & Brayne, C. (2005). The CAST (Childhood Asperger Syndrome Test): Test accuracy. Autism, 9(1), 45–68. SAGE Journals Database.
Institutional Website: University of Cambridge. (n.d.). Childhood Autism Spectrum Test (CAST). Autism Research Centre.
GADS (Gilliam Asperger's Disorder Scale)
Professional Test Manual: Gilliam, J. E. (2006). GADS: Gilliam Asperger's Disorder Scale: Examiner's manual. PRO-ED.
GARS-3 (Gilliam Autism Rating Scale, Third Edition)
Professional Test Manual: Gilliam, J. E. (2014). Gilliam Autism Rating Scale–Third Edition (GARS-3). PRO-ED. APA PsycNet Database.
Part 2: Clinician-Administered & Observational Instruments
ADI-R (Autism Diagnostic Interview-Revised)
Professional Test Manual: Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism Diagnostic Interview-Revised (ADI-R) examiner's manual. Western Psychological Services. Springer Link Reference.
MIGDAS-2 (Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition)
Professional Test Manual: Monteiro, M. J. (2018). MIGDAS-2: Monteiro Interview Guidelines for Diagnosing the Autism Spectrum: Examiner's manual. Western Psychological Services.
ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition)
Professional Test Manual: Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2012). Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) manual. Western Psychological Services. Massachusetts General Hospital Lurie Center Guide.