Autism is a form of neurodiversity, a difference in how one’s brain is wired compared to those of non-autistic people. It comes on a spectrum, meaning that each individual has a different mix of characteristics.

Autism is a neurodevelopmental condition, meaning that it is present throughout one's life, beginning with early childhood. Core traits of autism include differences in social communication, difficulties in understanding or expressing feelings, restrictive and repetitive behaviours and sensory processing.

It can present day to day difficulties and often be misunderstood. Many autistic people have co-occurring conditions such as anxiety, depression, Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD). Oftentimes these conditions can mask autistic traits, making one's areas of difficulty a bit more challenging to understand.

You might decide to go through the assessment process to obtain a diagnosis, in order to better understand yourself or your relationships, or to find ways to generally improve your mental health.

If you decide to have an Autism Spectrum Disorder (ASD) assessment as an adult, read on to learn what to expect.

How an adult autism assessment works

Autism assessments take between 1 hour and 30 minutes and 3 hours. They are conducted by a multidisciplinary team consisting psychologists and/or mental health nurses, as well as a psychiatrist.

Mental health professionals who conduct autism assessments need to have undergone specialised training in autism. Not all mental health practitioners, including not psychiatrists, are able to perform this assessment. It is therefore important to book an assessment with a suitable professional.

Before the assessment, you will be sent a short screening questionnaire, called the AQ-10 (Autism Quotient 10), which consists of ten questions. If you score above a threshold of 4 , then you will proceed to see a mental health nurse and/or psychologist, followed by a psychiatrist. The session with the psychologist and/or mental health nurse and with the psychiatrist might happen on separate occasions.

Autism assessments with a psychologist and/or mental health nurse

A specialised psychologist and/or mental health nurse will administer a version of the Autism Diagnostic Observation Schedule (ADOS). This questionnaire is designed to be flexible, allowing for modifications based on the individual's age, developmental level, and language abilities.

During the assessment, the administrator will observe your behavior, interactions, and responses to various tasks and activities. The observations are then scored and used to determine if the individual meets the criteria for an autism spectrum disorder.

Autism assessments with a psychiatrist

A psychiatrist will consult with the psychologist or mental health nurse and consider results of the ADOS, along with other information gathered through developmental and medical evaluations to complete the assessment. The psychiatrist will take a general history and look to understand current concerns, as well as administer further questionnaires in line with the Diagnostic and Statistical Manual 5 (DSM-V).

Psychiatrists may also ask information from parents, siblings, or someone that knows the client well and for enough, in order to better understand the developmental history of the client.

How adult autism assessments differ from child assessments

While the core principles of diagnosing autism spectrum disorder (ASD) remain consistent across all ages, there are notable differences between how assessments are conducted for adults and children.

For children, developmental history is a key component of the assessment process. Parents or caregivers provide detailed accounts of the child's developmental milestones, behaviors, and social interactions from early childhood onwards. In contrast, obtaining a comprehensive developmental history for adults can be more challenging, especially if records are sparse or if key informants (like parents) are unavailable. Adults may need to provide their own recollections of their childhood, supplemented by any available records or reports.

The tools and methods used in assessments also differ. Child assessments often involve a combination of observation, parent interviews, and standardized tools designed for younger age groups. Commonly used tools include the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). While some of these tools can be adapted for adults, there are specific instruments developed for adult diagnosis, such as the Adult Asperger Assessment (AAA) and the Autism-Spectrum Quotient (AQ). Adult assessments focus more on self-reported experiences and behaviours observed in adulthood.

Behavioural presentation varies significantly between children and adults. In children, autism-related behaviours such as delayed speech, difficulty with social interactions, repetitive behaviours, and sensory sensitivities may be more overt and pronounced. For adults, who may have developed coping strategies that mask their autistic traits, assessors need to identify subtler manifestations of ASD. These might include difficulties in maintaining relationships, employment challenges, or a history of mental health issues like anxiety and depression.

The context of the life stage further differentiates the assessments. For children, the primary focus is on their current functioning and future developmental support. Recommendations often include educational accommodations and interventions aimed at fostering social, communicative, and academic skills. In contrast, assessments for adults consider the impact of ASD on various aspects of life, including work, relationships, and independent living. Recommendations for adults may encompass workplace accommodations, support for daily living, and strategies for managing social interactions and mental health.

The professionals involved in the assessment process also differ. Child assessments typically involve a multidisciplinary team, including paediatricians, child psychologists, speech and language therapists, and occupational therapists. Adult assessments may involve clinical psychologists, psychiatrists, and occupational therapists experienced in adult autism. The process may also require input from mental health services if there are co-existing conditions like anxiety or depression.

Finally, the goals of the assessment vary between children and adults. Early diagnosis in children aims to provide timely interventions that support the child’s development, helping them reach their potential and improve their quality of life. For adults, the assessment often focuses on understanding long-standing challenges, gaining clarity on past behavioural patterns, and accessing appropriate support and accommodations to enhance current and future quality of life.

While both adult and child autism assessments share the goal of accurately diagnosing ASD and providing necessary support, they differ significantly in terms of developmental history, assessment tools, behavioural presentation, life stage context, involvement of professionals, and the overall goals of the assessment. Understanding these differences helps tailor the diagnostic process to meet the unique needs of each age group.

Autism assessment outcomes and further steps

If you are, indeed, autistic, the psychiatrist may tell you that you meet the criteria for Autism Spectrum Disorders (ASD). Together with you, the psychiatrist will put together a plan to support you in areas of difficulty identified during the assessment. Further steps may involve psychoeducation, therapy, coaching or signposting to support groups and other resources.

They may also recommend suitable medication for conditions such as depression and anxiety, or suggestions that you have an ADHD assessment, if there is reason to believe that ADHD could also be present. There is no pharmacological treatment for autism, and many argue that since it is a neurodivergence, a natural variability in among brains which should be understood and accepted by society, rather than changed.

Please note that in order to get assessed with a psychiatrist working with Augmentive, you do not need a GP referral.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from a private adult autism assessment to help finding an autism specialist near you to support you on your journey.

If you have a question about mental health, like the relationship between ARFID and autism, we’re here to assist on your journey. Our free 15 minute consultation can guide you to the most relevant specialists to answer your questions and discuss next steps.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any therapy, diet, exercise, or any other health-related programme.