Should You Test for Autism Online or in Person?

Elemy
Updated: December 17, 2021

Today, more people are turning to online options for their health care, but are online autism tests reliable?

While an online autism test can help to assess the presence of certain symptoms, it is no substitute for an in-person assessment by a diagnostic physician. You cannot receive an autism diagnosis from any online test.

Diagnosing Autism

To understand whether you should be tested for autism, it is necessary to understand how traditional autism diagnoses work. When diagnosing autism spectrum disorder in children, a pediatrician is usually the first step in this process.

All children should be assessed when they are 18 to 24 months old to make sure they are meeting all developmental milestones. These checkups are recommended for all children, even if the parent or caregiver doesn’t suspect autism or any other neurodevelopmental disorder.

The pediatrician observes the child and asks questions of the parents, including whether there is a family history of autism or similar conditions. Other questions include whether the child has smiled by 6 months, whether the child started to mimic facial expressions and sounds by 9 months, and whether they were making baby noises (babbling and cooing) by their 12th month.

Specific to autism spectrum disorder, the pediatrician will want to know whether the child:

Displays any unusually repetitive behaviors.
Avoids making eye contact with others.
Responds when someone tries to get their attention.
Speaks only in a monotone or does not speak very much at all.
Displays unusual sensitivity to noise, lights, temperatures, smells, or other changes in their environment.
Has any difficulties with sleep or digestion.

The Nuances of Evaluation

Answers to these questions give the pediatrician clues as to whether the child’s brain is developing on schedule or if there is a need to consult a team of autism or neurodevelopmental specialists, who look at everything from psychology and speech-language pathology to physical development. Often, a neurologist and a developmental pediatrician are also involved in this evaluation, to check factors such as cognitive level, language skills, and how the child eats, dresses themselves, and uses the bathroom.

Medical professionals are well-versed in the symptoms of autism and other developmental disorders. They know what to look for in children at different ages and what different presentations look like. You can’t replicate this kind of assessment in an online test.

Many nuances would be lost in an online test for autism, especially if parents do not have an opportunity to ask clarifying questions or provide additional details. Additionally, an online test will likely not be able to holistically cover every relevant detail about the child’s history, behavior, and environment to make a sound conclusion on the likelihood of autism being present.

Online Autism Tests

Online autism tests do exist, like this one. However, they exist only as a screening measure to give a person an idea of whether or not they should contact a health care professional or a specialist about a suspected diagnosis of autism spectrum disorder. An online test is not able to diagnose autism spectrum disorder.

That said, an online test for autism is not without its uses. If a person suspects they have autism, or they know someone who does, an online test may help confirm (or reject) that speculation and give a person some insight into what they should do next.

An example of this is the M-CHAT (the Modified Checklist for Autism in Toddlers), which is a popular online screening tool. Lineagen, the company that owns the rights to the test, makes it clear that the test cannot diagnose autism. Instead, it is intended to help patients and caregivers determine whether a child has the symptoms of autism and how to present this information to a pediatrician or a child developmental specialist.

Other tests will offer to pass the results along to a specialist trained to diagnose autism, but even this will not suffice as an official diagnosis of autism. A specialist receiving the results of such a test will call the parents and child in for full evaluation, effectively starting the process from scratch.

Online autism tests provide some benefits for people who don’t know how to ask if their child has autism or want a screening tool to give them some insight into their concerns. While the best online tests are designed to be as comprehensive and helpful as possible, they are still no substitute for an established medical assessment from a specialist. This kind of evaluation will only happen in an in-person setting.

Additionally, people taking an online autism test may suspect they, or their child, have ASD. This might influence how they respond to the questions.

Online Testing for Adults

Some researchers are working to bridge this gap and to bring a greater sense of reliability to online tests for autism.

The Adult Repetitive Behavior Questionnaire test determines the degree to which adults with possible autism are affected by repetitive and restrictive behaviors. The test was developed by researchers at Cardiff University in the United Kingdom, who said that they created this system where people can do a self-assessment for this core symptom of autism.

Writing in the Journal of Autism and Developmental Disorders, the researchers point out that many of the behavioral checklists specialists use for diagnosing autism are aimed more at children than adults, and adults are more effective at hiding their autism symptoms than children. For this reason, there are challenges in finding psychologists and specialists who are adept at diagnosing autism spectrum disorder in adults. Those who do use methods that are less vetted than those used in diagnosing autism in children.

The Adult Repetitive Behavior Questionnaire test is designed to help participants determine whether repetitive and restricted behaviors (compulsively arranging items in patterns, for example) occur abnormally often or with unusual severity. To make the test reliable, the researchers worked with autism experts in two countries to ask more than 300 adults to complete the test. Half of the adults who completed the test had been diagnosed with autism spectrum disorder, and the other half had no such diagnosis.

According to the researchers, some adults who did not have autism reported that they had a high tendency to perform repetitive behaviors. But those who had been diagnosed with autism scored significantly higher.

Online vs. In-Person Autism Testing

Again, the researchers are clear that the questionnaire is not an autism diagnosis in and of itself. There are many core symptoms of autism that the test cannot test for and that a self-assessment cannot genuinely evaluate.

Nonetheless, the fact that the test exists is an “important advance” for adult health care, according to experts familiar with the design. The idea is to provide adults who wonder if their repetitive and restrictive behavior is a sign of a neurodevelopmental disorder with a tool to help them determine if they need to seek help. It can also guide them in how to ask initial questions to start the process.

The COVID-19 pandemic may have hastened the pace at which online tests are designed for families and individuals who suspect autism spectrum disorder. However virtually all specialists, professionals, and experts still recommend getting an in-person assessment. This is necessary to get an official diagnosis.

There is no test that can examine the full range of symptoms that autism causes. For as much as an online test can ask questions about restricted and repetitive behaviors, only a trained eye can notice the more subtle cues of communication and social disorders that are often at the core of autistic behavior.

Online tests have a helpful role to play, but there is no online test that can, or should, be able to diagnose autism spectrum disorder with any degree of clinical legitimacy.