How do you evaluate for autism?

A diagnosis of ASD is based on careful history gathering, evaluation, and behavior observations by a highly trained professional.  There are numerous tools that providers use in gathering the data that is needed to determine whether an ASD diagnosis is appropriate for a given individual. 

While some evaluations need only look at the specific question of autism, most children require a more comprehensive process.  For example, the presence of behavior challenges, academic concerns, delays in navigating the tasks of daily living, and/ or communication difficulties warrants additional attention and assessment.  We draw on caregiver and teacher perspectives to help us learn about a child. For younger children whose issues are showing up at school, we may suggest a school observation so that we can directly observe classroom functioning and peer interactions.

Does the process look different for girls who may be on the spectrum?

Thankfully, there has been great progress in the field about how autism in girls might differ from how autism is expressed in boys. There is discussion in the literature about a “female phenotype” of autism. The female autistic phenotype is considered to be less obvious than stereotypes of how autism manifests. While growing awareness about the female phenotype is an advancement, we also need to acknowledge that many autistic individuals who were assigned female at birth may later go on to be nonbinary, trans, or gender fluid. It’s also true that many males can present with less obvious, or more nuanced, presentation of autism. We find it helpful to acknowledge that nuanced presentations may be present, regardless of an individual’s gender identity.

Familes often ask us whether the assessment process differs for girls when there is a question of autism. The answer is yes and no. We may use the same set tools to gather data, but we acknowledge that scores on these measures may not reach the autism threshold, even for individuals whom we feel meet criteria for autism. Again, sensitivity to the various ways that autistic features can be expressed is relevant to all children we see, regardless of gender identity. It’s also important to debunk myths about autism. A common misunderstanding that we encounter is that if a child is empathetic, they can’t possibly be autistic. The reality is that most autistic individuals not only have intact emotional empathy but they may be especially sensitive to other people’s feelings, animal welfare, and social justice.

For all individuals who are seeing us for a neurodevleopmental evaluation, we prioritize gathering information from multiple sources as a way of forming as complete a picture as possible. We find that using a comprehensive set of evaluation tools is especially important when assessing young people with nuanced presentations of autism. We work hard to stay up-to-date on the rapidly developing literature about autism and we support the current paradigms that celebrate neurodiversity.

Please refer to the overview page for general information about the evaluation process.

Child and Teen Solutions (CATS) is a mental health clinic based in Seattle, Washington. We are staffed by psychologists and therapists who specialize in children, teens, young adults, and parent coaching. We offer treatment and evaluation services. We offer both in-person and telehealth services for therapy. Our office is located in the Madison Park neighborhood, near Lake Washington.