Autism assessment must consider contributions to the child or adolescent’s current functioning. Much of this information is obtained prior to the evaluation.  Family and social history, health and development, education, and assessment and services history informs the autism evaluation outcomes. Children who present for autism assessment often have other neurodevelopmental, medical, or mental health concerns which need to be considered. Common co-occurring conditions include ADHD, Language Disorder, Intellectual Developmental Disorder, sensory processing differences, and seizure disorders.

Support planning is also greatly informed by history and document review, such as recommendations for continuity of current or new services. School information can be very helpful such as the most recent Competency Based IEP and the previous 2 final report cards. Ideally, this information is obtained before the assessment day. For children with language delays, a hearing screen or audiological evaluation will be needed. This can be requested through a Speech-Language Pathologist or the Family Physician.

For young children, autism evaluations are multidisciplinary and must follow the BC Ministry of Health standards and guidelines. This practice is aligned with the Pediatric Association of Canada guidelines for assessment of autism. More information is available at: Canadian Pediatric Society

Children below 6 years of age require an evaluation of language functioning by a Speech-Language Pathologist. Consultation from a Pediatrician, or an active pediatric referral, are required in advance of the autism assessment. Reports from other professionals, such as the child’s Occupational Therapist or Supported Child Development Worker, are often informative.

Evaluations involve specialized assessment tools. Children and adolescents with suspected autism participate in the Autism Diagnostic Observation Schedule – Second edition (ADOS-2). The ADOS-2 is a standardized play and interview, recording, and rating system for social communication and behaviours as well as repetitive and sensory behaviours associated with autism. The Autism Diagnostic Interview - Revised (ADI-R) involves parents or caregivers. The interview protocol examines three main areas affected by autism based on signs and symptoms as they emerge in early life and currently: reciprocal social interaction, social communication, and stereotypic patterns of behaviour. Autism travels alone infrequently. Other neurodevelopmental and mental health conditions are often a part of the presentation and need to be considered for a comprehensive evaluation. Assessments are structured based on age, developmental competencies, and professional and governmental practices and regulations.

Ages 2 to 5 Years

Children below 6 years participate in a developmental assessment which begins with the parent/caregiver interview prior to formal evaluation of the child. Parents or caregivers complete adaptive functioning and behavioural surveys. If available, it is helpful to have these forms completed by other Knowledgeable persons such as the preschool teacher. In the office setting, an evaluation of cognitive functioning completes the developmental assessment component. The cognitive assessment and ADOS-2 observation session are usually conducted in the morning. The ADI-R session with parents or caregivers typically follows the child’s evaluation. The autism diagnostic interview is usually completed on the same day but can be offered in another appointment or by distance depending on family preferences.

Ages 6 to 19 years

The ADOS-2 activities are organized based on the expressive language skills. The ADI-R is usually administered on the same day. For children and adolescents, completion of a behaviour survey prior to the assessment is helpful. Cognitive and adaptive assessment may not be necessary unless there are indications of developmental delays. However, the co-occurrence of autism and Intellectual Developmental Disorder is high and there are overlapping presentations.

Autism Diagnostic Assessment Report

Once the assessment is complete, a report is generated which identifies relevant background history, methods used, results, formulation, and recommendations.

The provincial Autism Funding Unit of Child and Youth with Special Needs (CYSN) requires the assessor to complete specific forms confirming an autism diagnosis. The federal Disability Tax Certificate application and provincial eligibility forms for CLBC are completed on request.