Our NHS Right to Choose autism assessment process

You will meet with an ADI R trained specialist clinician for the Autism Diagnostic Interview Revised (ADI R). This appointment can last up to three hours. It is a detailed developmental history interview, which means we explore your child’s development from an early age.

You will be asked a wide range of questions about your child’s behaviour and experiences, including:

• language and communication

• social interaction and relationships

• patterns of behaviour and interests, including routines and sensory differences

• day to day functioning at home and in education

Many questions focus on your child’s early years, often around ages 4 to 5, because this can help identify long term patterns. We also discuss your child’s current presentation and what life looks like for them now.

Preparing for your ADI R

It can help to spend a little time gathering information in advance. You do not need to remember everything perfectly, and it is normal to be unsure about some details.

If it is available, you may find it helpful to:

• look at early photos or videos to jog your memory about play, social interaction, and communication

• have your child’s red book and any early health visitor or nursery notes to hand

• note down key milestones, such as first words, social play, sleep, eating, and sensory sensitivities

• bring examples of what your child finds difficult and what helps, including routines and supports that work well

• gather any relevant school or nursery information, such as reports or SEND support plans, if you have them

Your child will meet with a different specialist clinician for the Autism Diagnostic Observation Schedule Second Edition (ADOS 2). This appointment usually takes up to 60 minutes.

ADOS 2 is a standardised observational assessment of:

• communication

• social interaction

• play or imaginative use of materials

• restricted and repetitive behaviours and interests

This appointment is different from the ADI R because it is not based on developmental history. It focuses on your child’s current skills and behaviour. It can be used with children and young people across different developmental levels, from those with no speech to those who are verbally fluent.

During the appointment, the clinician uses a structured, child friendly approach, which may include activities, toys, games and conversation topics. This helps the clinician observe your child’s communication and social responses in a consistent way. The clinician may look at things such as eye contact, gestures, body language, social responses, play, imagination, and any repetitive behaviours.

If your child’s ADOS 2 is online

Some ADOS style assessments are delivered online using an adapted, evidence-based approach. If your appointment is online, we will give you clear instructions in advance.

To help your child feel comfortable, it can be useful to:

• choose a quiet space with minimal distractions and a stable internet connection

• use a laptop or tablet, so your child can be seen clearly and can move naturally

• set up the camera so the clinician can see your child’s face and upper body, and ideally their hands during activities

• have a small selection of everyday items ready if requested, such as simple toys, paper and pens, or objects your child can use for play

• avoid coaching your child on what to say or do, as the clinician needs to see natural communication and behaviour

• plan a calm lead in, with time to settle beforehand, and a break or preferred activity afterwards

If your child becomes anxious or needs a pause, that is expected and the clinician will guide you through what to do.

After both appointments have taken place, the clinicians bring together all of the information from your child’s assessment. This includes the questionnaires, the ADI R developmental history interview with you as a parent or carer, and your child’s ADOS 2 appointment.

Each part of the assessment looks at a different aspect of your child’s development and day to day experiences. By reviewing these together, the clinicians can build a clear and balanced understanding of your child’s strengths, needs and presentation over time. The information is reviewed against recognised diagnostic criteria using an evidence based approach. This helps ensure the outcome is thorough, consistent and clinically sound.