What Is an Autism Assessment? Exactly What to Expect

Elemy
Updated: April 18, 2022

One of the many challenges of autism spectrum disorder (ASD) is that there are no objective, clear indications of a medical state that can be accurately observed and measured from outside the patient. There’s no single gene, blood test, or other biomarkers that alone indicate ASD. For this reason, autism can only be diagnosed after a process of interviews and observations by professionals.

Online Autism Assessments

An initial autism assessment can be conducted at home, before the involvement of a pediatrician or developmental specialist. Indeed, parents and caregivers are often encouraged to conduct and record such observations. These tools can give parents peace of mind and play an important role in early diagnosis.

This has led to many established researchers and organizations developing online assessment tools that are easy enough for non-medically trained parents to use and comprehensive enough that the data the tools produce will be of use to pediatricians and specialists.

Online autism assessments should not be thought of as a replacement for a full diagnostic evaluation, but they are very good starting points for parents and caregivers who suspect that their child might have some form of autism. They’re especially helpful for families who have no prior experience or understanding of autism spectrum disorder.

Online autism assessments can return results quickly, answer basic questions about symptoms, and help in the decision-making process of whether to seek out a professional diagnosis.

One such autism assessment tool that Elemy uses is the MCHAT-R/F. It’s designed to identify children who may benefit from a more thorough autism evaluation.

Autism Assessments and Pediatrician Appointments

While it is possible to do an autism assessment online, an in-person screening for autism, whether by a pediatrician or a developmental specialist, will be a very different experience.

For a child, your pediatrician will look for any signs of delayed development or communication at the first well-child visit. The observation will cover basic behaviors like giggling and crying, where your child looks (they should look to you, as parents or caregivers, for reassurance), how your child tries to get attention, how your child responds to their name, as well as motor skills like pointing, waving, and other standard gestures.

The information derived from those observations, in addition to family history, health examinations, and the parents’ own observations and reporting, constitute an autism assessment.

To conduct these observations, pediatricians have a number of tools at their disposal. All tools will look at a child’s behavioral and communication development but will measure the development in different ways, to provide a complete picture of the child’s progression towards expected goals.

Autism Assessment Tools

MCHAT-R/F

As mentioned before, one of the most common such tools is the Modified Checklist for Autism in Toddlers – Revised with Follow-up, or the MCHAT-R/F. Parents fill out its 23 questions, and, based on their responses, pediatricians can start talking to parents about any perceived language delays or behavioral concerns that their child is experiencing.

For example, one of the questions on the MCHAT-R/F asks whether a child follows your gaze or gesture (in other words, if you turn your head to look at something, does your child also look to see where you are pointing)? If the answer is no, this would indicate a risk for autism. Similarly, another question asks if your child is distressed by everyday noises, like reacting by screaming or crying when they hear a vacuum cleaner or a passing siren. If the answer is yes, this would also suggest a risk for autism.

If the MCHAT-R/F suggests the likelihood of autism spectrum disorder, parents have the option of taking another autism assessment tool or taking the results of the MCHAT-R/F to a pediatrician, who will then work with the parents on starting genetic or developmental testing to confirm the presence of autism.

The MCHAT-R/F is thought of as the gold standard of parent- or caregiver-based questionnaires. However, for all the tools that can be used in an autism assessment, it is important to remember that assessing for autism is not a diagnosis of autism. Even if a child has developmental delays, this could indicate one of many disorders similar to autism, but not on the autism spectrum. Autism assessments do not identify all children who have autism spectrum disorder. For example, the Pediatrics journal points out that the success rate for the MCHAT-R/F is not 100 percent, which speaks more to the complex nature of autism spectrum disorder than it does to problems with the assessment rubrics. This is why for all the assessment tools a pediatrician uses in an autism assessment, they will also conduct interviews with parents to determine health and family history, to better identify children who may be at risk for autism.

Ages and Stages Questionnaire

Another tool that can be used in an autism assessment is the Ages and Stages Questionnaire (ASQ), which is a general development screen tool that is completed by parents. It consists of 19 questions that screen for age-specific milestones in the following categories:

Communication
Gross motor skills (whole body movements involving the large muscles in the arms, legs, and torso)
Fine motor skills (using small muscles to perform careful, precise tasks)
Problem-solving skills
Personal adaptive skills (whether the child can dress and groom themselves, use the toilet properly, etc)

Children with autism spectrum disorder will have some degree of impairment in one, some, or all of these categories, which is why the ASQ is commonly used in an autism assessment.

ADI-R and CARS

Another diagnostic tool is the Autism Diagnosis Interview (Revised), or the ADI-R. This is an instrument that assesses the presence of autism spectrum disorder in both adults and children and is usually administered to people aged 18 months and above. It focuses on three expressions of behavior:

Reciprocal social interaction (back-and-forth dialog, like having a simple conversation and sharing interests and ideas with another person)
Communication and language
Restricted, repetitive, stereotyped interests and behaviors (that would be consistent with an autism diagnosis)

The Childhood Autism Rating Scale (CARS) is a short assessment that can be used for any child after their second birthday, who shows some signs of delayed development. It is a useful tool to distinguish children who have other developmental disorders, from children who have autism spectrum disorder.

The Role of Autism Assessment Tools

There is no single tool in an autism assessment that should be used as the basis to diagnose a child with some form of autism spectrum disorder. Any diagnostic tool will use a professional’s observation of the child’s behavior and communication, as well as the parents’ descriptions of their child’s behavior, communication, and development at home.

However, autism assessment still has an important role to play, and it is often the first step in the process of determining whether a child is a likely candidate for a diagnosis of autism spectrum disorder.