Autism Spectrum Disorder (ASD) Assessment 

A neuropsychological assessment adapted for autism spectrum disorder (ASD) makes it possible to identify the key signs of ASD.

What is the Autism Spectrum Disorder (ASD) Assessment

A neuropsychological assessment adapted for autism spectrum disorder (ASD) makes it possible to identify the key signs of ASD and to determine whether the child or adult meets the DSM-5-TR diagnostic criteria.

The assessment of autism spectrum disorder is, above all, a clinical process.
There is no single “test” to diagnose ASD.
The assessment must take into account age, gender, cultural context, and comorbidities.
Collaboration with the family is essential.

ASD assessment is based on a clinical interview and standardized clinical tools. It includes four main components:

1. Assessment of behaviours associated with autism spectrum disorder

This assessment relies on validated and standardized clinical rating scales. It considers behaviours observed by parents, teachers, or other professionals (for example, educators). When assessing ASD in an adult, parents, a spouse, or other close individuals provide information about behaviors in daily life.

2. Assessment of behaviours associated with ASD

Nonverbal behaviors: eye contact, facial expressions, gestures, posture, etc.
Verbal communication: expressive and receptive language, pragmatics, prosody, etc.
Social interactions: ability to initiate and maintain interactions, understanding of emotions, etc.
Interests and activities: intensity and nature of restricted interests, motor stereotypies, etc.

3. Clinical assessment of emotion recognition and interpretation, as well as cognition, perception, and social judgment

This assessment analyzes the skills needed to understand, describe, and represent the mental states of others, and to use these representations to explain or predict their behaviour.

Examples:

Recognizing and understanding the perspective, thoughts, and intentions of others. Identifying the emotion a person may feel in a given situation.
Understanding social rules and solving problems related to social situations.

4. Assessment of the neuropsychological profile, including the cognitive signature typically associated with autism spectrum disorder

The assessment also helps rule out other possible diagnoses that could explain the symptoms (for example, intellectual disability, language disorder, anxiety disorder, personality disorder in adults, etc.).

Ultimately, the goal of ASD assessment is not only to identify the core features of the disorder, but also to uncover the individual’s unique characteristics, interests, and abilities.

Note: At Centam, we do not use the ADOS-II instrument, because we believe this test has several significant limitations that affect the interpretation and validity of its results:

Outdated concepts: ADOS-II (child and adolescent) diagnostic concepts are based on the DSM version from 1994
Outdated diagnostic criteria: ADOS-II (child and adolescent) diagnostic criteria are based on the DSM version from 1994

Note: the latest version of the DSM, provides a major revision of the diagnostic concepts and criteria for ASD

High risk of false diagnoses: Recent studies show that ADOS-II has a high false-positive rate for ASD ranging from 29% to 34%. In other words, its use is associated with overdiagnosis of ASD (Green et al., 2022; Hong et al., 2022).

Recent research by Barbaresi and colleagues (2022), published in JAMA Pediatrics, highlights sensitive clinical approaches and tools, such as those we use in our evaluations, demonstrate a level of sensitivity equal to or greater than traditional instruments.

At Centam, we choose not to rely on the ADOS-II for diagnosing autism spectrum disorder (ASD). While widely used, this instrument presents several important limitations that affect its validity and reliability:

Outdated framework: The ADOS-II was developed using DSM-IV (1994) concepts, which no longer reflect the updated definitions of ASD in the DSM-5-TR (2013; 2022).
Outdated diagnostic criteria: The ADOS-II scoring system is based on DSM-IV-TR (2002) diagnostic criteria, which no longer reflect the updated definitions of ASD in the DSM-5-TR (2013; 2022).
Risk of overdiagnosis: Recent studies show false-positive rates as high as 29–34%, meaning many individuals may be misdiagnosed as autistic using the ADOS-II (Green et al., 2022; Hong et al., 2022).
Missed cases in certain profiles: Adults, women, and individuals with strong compensatory strategies (camouflaging) often score below diagnostic thresholds, despite meeting criteria in daily life (Lai et al., 2015).
Gender bias: Research shows reduced sensitivity for females, who may present with different or subtler signs (Ratto et al., 2018).
Comorbidity effects: Psychiatric conditions such as anxiety, psychosis, or language disorders can inflate ADOS-II scores, leading to confusion with autism (Havdahl et al., 2016).
Ecological validity: Because the ADOS-II is administered in a structured, artificial setting, it may not capture how behaviors appear in natural environments like home, school, or work (Maddox et al., 2017).
Cultural and linguistic bias: Studies have raised concerns that ADOS-II norms and materials are not adequately adapted to diverse cultural and linguistic contexts, limiting its validity outside its original standardization samples (Kalb et al., 2022).
Lack of stability and consistency over time: The results of the ADOS-II can change depending on who gives the test and when it is given. In other words, two different evaluators may not always reach the same conclusion for the same person, or the same person may get different results if tested again a few weeks later. This lack of consistency can create uncertainty and increase the risk of an incorrect diagnosis (McCrimmon & Rostad, 2014).
Not sufficient on its own: Even its own developers stress that it should not beused as the sole diagnostic tool (Lord et al., 2012).
Additional cost and burden: Using the ADOS-II requires an extra assessment session. This almost doubles the cost of the evaluation and obliges the individual (and often their family) to spend an additional day in assessment, which can be tiring and stressful.

Instead, we base our evaluations on sensitive, validated clinical approaches supported by recent research (Barbaresi et al., 2022, JAMA Pediatrics). These methods not only allow us to meet the highest scientific standards, but also to consider the individual’s unique profile, strengths, and challenges—something no single test can achieve.