Assessment Process

When a client decides to proceed with an assessment with us, they are allocated an assessment coordinator who will act as their first point of contact throughout the assessment process. Our friendly coordinators will gather background information, liaise with schools and informants (where appropriate) and arrange the assessment sessions. They will act as a conduit of information between clients and the clinical team, and will arrange direct contact with a clinician if needed.

The first step in our autism assessment process is gathering background information. This not only provides us with information needed as part of the assessment but allows us to plan the most appropriate assessment. For example, we need to understand a child’s language level to determine what ADOS 2 module to use and to plan an adult assessment we need to consider whether there is an informant who can report on childhood or not.
At this stage, we will also ask our clients to complete some autism screening tools. These provide us with information about the autism characteristics experienced. For children, the forms are usually completed by parents and for adults some forms are completed by the client and others by someone who knows the client.

The screening tools we use are selected based on circumstances and include the Modified Checklist for Autism in Toddlers (M-CHAT), Autism Quotient (AQ50) and Empathy Quotient (EQ50).

Our background information forms can easily be completed on a phone, tablet or computer at our clients’ convenience.

If the assessment is for a child or young person who attends an educational setting, we will ask for consent to contact the setting. When consent is obtained, we will contact the educational setting to gather information from them also.

There are two appointment sessions completed by two different clinicians as part of the autism assessment. One session focuses on observing our client’s current social communication and interaction, behaviours and characteristics whereas the other session looks at autistic characteristics experienced or observed in a broader context currently and historically. We explain these further below.

In order to complete the observation of current social communication and interaction, behaviours and characteristics, our team uses the Autism Diagnostic Observation Schedule (ADOS 2).

The ADOS 2 is a gold standard, internationally recognised autism assessment tool. The ADOS 2 has 5 modules which are selected based on the client’s age and level of language.

For younger children the ADOS 2 involves fun interactive activities and play, and there are lots of toys for children to explore. For older children and adults, the session involves some set light-hearted tasks, questions and conversation.

When clinicians complete the ADOS 2 they observe the way in which the client communicates and interacts along with looking for behaviours associated with autism. These observations are recorded qualitatively and also scored using the ADOS 2 scoring system. The scores are then interpreted using the ADOS 2 algorithm and utilised within the multi-disciplinary review of information gathered during the assessment.

The way in which we gather information about the presence of autistic characteristics in a broader context and historically varies depending on the client’s specific circumstances.

For the majority of child clients, the Autism Diagnostic Interview – Revised (ADI-R) is conducted with the child’s parent(s) or caregiver(s). The ADI-R is a semi structured interview which probes for behaviours associated with autism both currently and in early childhood. The clinician will gently question parents around behaviours such as how the client responded to certain situations, got their needs met or spent their free time when younger and/or currently. In a similar way to the ADOS-2, information gathered during the interview is recorded both qualitatively and using the ADI-R scoring algorithm.

Where a child is in specific circumstances and may not have someone who can report directly about their experiences in earlier childhood, we take a bespoke approach to gathering the information we require to complete the assessment.

The way in which we gather information about autistic characteristics for adult assessments depends on whether the client has a reliable informant that can take part in the assessment, and who that informant is.

If an adult has an informant who knew them when they were aged 4 – 5 and can reliably report on the client’s behaviours at this age, our preference is to complete the ADI-r with that informant in the same way as when we complete a child assessment.

However, if the adult client does not have an informant who knew them in childhood or if the client does not things that an informant can reliably provide information about them when younger, we will conduct an interview with the client themselves to gather this information.

When completing the interview with the adult client themselves we use either the Autism Clinical Interview for Adults (ACIA) or Ritvo Autism Asperger Diagnostic Scale–Revised (RAADS–R), depending on which is more appropriate. Both tools are designed to gather information about social interaction, communication and behaviour currently and in childhood.

After we have gathered the range of information we require, the clinicians who have been directly involved in the assessment and at least one other clinician come together as a multi-disciplinary team to review the information gathered.

If at this point, the team feel that they need more clarity on some of the information, they may request an additional meeting with the client or may request additional information using tools such as the Camouflaging Autistic Traits Questionnaire (CAT-Q).

The clinical team then review all information and consider the evidence we have that supports the diagnostic criteria for autism spectrum disorder as set out in the Diagnostic and Statistical Manual, 5th Edition (DSM 5).

We then complete the report, including all the information gathered, reasons for the outcome and recommendations for next steps and issue it to the client.

Following the assessment conclusion, clients are offered an optional feedback meeting. This meeting is not structured in any way and can be used in the way that the client finds most useful. The meeting can be used to review the report, discuss specific findings in detail, consider the recommendations or ask for advice around specific issues or needs.