A Comprehensive Guide to Autism Psychological Testing and Reports
Overview: This article describes the common steps in a psychological evaluation, assessing for autism, and the benefits of obtaining a psychological report. Access the “Psychological Testing Toolkit” to guide any psychological testing process. Download the toolkit at the end of this article.
Autism is a complex neurodevelopmental disorder with symptoms that can vary widely among individuals and cultures. The condition is not easily diagnosed and is often misdiagnosed as other psychological or medical conditions. For these reasons, a thorough, research-based assessment is a critical part of an accurate diagnosis.
Screening
Autism is frequently detected in early childhood through a screening process by a primary care provider. These screenings are not generally sufficient to confirm a diagnosis given that symptoms can be the result of a multitude of other conditions, but they are often the first step in identifying the need for a full psychological assessment and diagnosis.
A primary care doctor may notice symptoms such as social avoidance, repetitive behaviors, or other traits, which alert the doctor that an autism screening is necessary. The doctor will start by compiling a comprehensive developmental history from parents or caregivers and conduct a preliminary screening using one of the tools described below. The results of this assessment will determine if the doctor is likely to refer the patient for a more comprehensive autism assessment. It is important to note that these screenings are not sufficient for diagnosis, but they are good barometers for a potential diagnosis.
Common Autism Screening Tools:
Modified Checklist for Autism in Toddlers, Revised (M-CHAT) –This is a quick, popular test designed for toddlers between 16 and 30 months old. Note: there is evidence that the M-CHAT may not be as effective in screening females, minorities, and children from low-income families.
The Ages and Stages Questionnaire (ASQ) – This is a general screening tool that examines children for developmental challenges at specific ages.
Screening Tool for Autism in Toddlers and Young Children (STAT) – The STAT is an interactive screening tool utilizing twelve activities designed to assess play, communication, and imitation.
Parents’ Evaluation of Developmental Status (PEDS) – This is not so much a test, but a general caregiver interview designed to identify delays in motor, language, and other developmental areas.
The need for a full autism assessment may also be noticed by mental health providers, such as therapists, consultants, and psychiatrists, usually based anecdotal evidence and clinical observation, and do not necessarily include the use of a standardized screening tool.
Psychological Testing
What is Psychological Testing?
A psychological assessment is a comprehensive evaluation of cognitive, behavioral, emotional, and social functioning using standardized tests and procedures. The assessment is conducted by a trained psychologist over a day or series of days. The aim is to identify strengths and weaknesses across various domains, such as memory, attention, language, problem-solving, and social and motor skills. The assessment aids in the diagnosis of conditions, guides treatment plans, and parses progress over time. The results provide valuable insights into how an individual’s brain function affects daily living and can inform interventions to improve quality of life.
Finding the right Psychologist
Finding a psychologist to complete a comprehensive evaluation can be a challenge, but it is worth the effort to ensure an accurate diagnosis. Start by requesting a referral from your primary care provider or therapist. Another option is to go to your child’s school district or insurance provider for a referral. This route may also help with the financial cost of the assessment. Before scheduling an assessment, ensure that the psychologist is trained and experienced in administering autism assessments (or other assessments that you’d like to be done) and that they will also provide a full written report for use with treatment, academic accommodations, and potential disability services.
What is in an Assessment?
To be of value, the testing must be comprehensive – meaning that it includes assessments for developmental history, cognitive, behavioral and emotional functioning, personality traits, and social abilities. If assessing for autism, then an autism specific measure must be a part of the test battery (commonly used autism tools described below). The assessment should include tests for each of the above variables in order to develop a comprehensive and complete understanding of the individual’s situation. For example, an autism test may come back positive, but if the person recently suffered a traumatic brain injury then the symptoms may be due to the injury even though they are similar to autism. A thorough assessment allows the psychologist to determine if the autism type symptoms have historically been present or if they are more likely a result of the injury. In this manner a good psychologist will collect as much data as possible to provide an accurate diagnosis.
Cost of the Assessment
A high-quality mental health assessment can be costly, ranging from $1,000.00 to over $10,000.00 depending on the psychologist and the tests conducted. This covers the cost of the measuring tools (many of which are patented and must be purchased by the administering professional), as well as the psychologist’s time in conducting the assessment and preparing the report. Many autism-specific assessment tools are expensive and require specialized training to administer, so that ASD assessments end up being more expensive than more standard assessments. Luckily, given that these tests are evidence-based and universally standardized, the costs are frequently covered by health insurance, school districts, disability offices, or other local charitable resources. It is important to investigate these financial options before paying for an assessment out-of-pocket.
Autism Assessment Tools
An autism assessment includes the collection of a comprehensive personal history and administration of one of the below described measures to determine if autistic symptoms are present. Most assessments typically use only one of these measures, other than SRS which is commonly used in conjunction with one of the other tests. Administering ASD assessments requires specialized training, and non-trained psychologists may not be qualified to administer each test. It is worthwhile to discuss which autism measure your selected psychologist will be using prior to the assessment to ensure the professional is accurately trained in administering the tests.
ADOS (Autism Diagnostic Observation Schedule) - The ADOS is a semi-structured, standardized assessment of communication, social interaction, and play or imaginative use of materials. It assesses current behavior and can thus be influenced by social anxiety, mood, and relationship difficulty. Given that potential deficiency, the ADOS requires historical data to complete the assessment and diagnosis.
MIGDAS (Monteiro Interview Guidelines for Diagnosing the Autism Spectrum) – This is an open-ended, sensory interview, including the use of games and/or toys, that allows for a more individualized assessment. The MIGDAS is approved for adolescents but can be used with adults as well. The MIGDAS also benefits from an interview of parents or caregivers to provide historical data.
ADI-R (Autism Diagnostic Interview – Revised) – The ADI-R is an interview of a parent or caregiver that focuses on behavior in three areas: qualities of reciprocal social interaction, communication and language, and restricted and repetitive, stereotyped interests and behaviors. The ADI-R is appropriate for children and adults. Given that it is a collateral interview, it is most often used when the assessed client is unable or unwilling to participate in the assessment.
DISCO (Diagnostic Interview for Social and Communication Disorders)- This consists of a detailed, semi-structured interview of the client designed to evaluate their developmental, behavioral, and social skills from birth to current day-to-day functioning. Although this is an interview, not an assessment, it is a valid tool for obtaining a history to confirm or refute an ASD diagnosis.
SRS-2 (Social Responsiveness Scale) – The SRS-2 is a collateral assessment that identifies the presence and severity of social impairment within the autism spectrum in the assessed client and differentiates it from that which occurs in other disorders.
Assessment Question
It is important that a testing psychologist understand why an individual or family is seeking an assessment. Much like going to a medical doctor, if they don’t know what hurts they may not discover what is causing you pain. When obtaining an ASD assessment, it is important to be prepared with questions you want answered as well as insight into your struggles, concerns, and fears. Open and honest communication with the testing psychologist is an essential to receiving an accurate assessment.
Testing Day/Days
The testing process can be demanding and exhausting. Psychologists typically collect collateral information from parents, caregivers, therapists, teachers, and/or other associated professionals via personal interview and/or questionnaires. This information is used to hone assessment question and measures used with the client
On the day(s) of the test(s), the client will be asked to complete a series of written questions designed to assess a variety of types of functioning. There may also be structured conversations, unstructured games, and tests that feel ominously like schoolwork. Individuals may also be asked to complete questionnaires before or after the in-person testing days.
The goal of testing is to acquire a complete and accurate understanding of the client’s capacity and functioning. To do so, it is essential that all participants are honest and forthright. The tests are designed to detect deception, but excessive dishonesty can invalidate measures and leave the psychologist with less reliable data to work with. It is equally important that the participants understand the questions and ask for clarification when needed. The assessment process is not a time for modesty or hesitancy.
If the person being evaluated uses psychotropic medication that information must be shared with the psychologist before test day. Some medications, such as antidepressants or mood stabilizers will likely not interfere with the assessment process, but the psychologist may request that ADHD or other prescription drugs not be taken the day of the assessment. Obviously, it would be difficult to assess for ADHD or the line if the person is using medication to reduce or manage the symptoms of the condition.
Bottom line is that the best test results occur when the assessed individual is genuine and natural. Psychologists are testing for strengths, weaknesses, and everything in between – truths that are easiest to identify when individuals present as their true, unaltered selves.
Psychological Report
The entire purpose of the assessment process is to receive a diagnosis in the form of a written report. This usually takes several weeks after testing while the psychologist deciphers all the collected data. This personalized document is a comprehensive analysis of the assessed person’s history, capacity, current state of functioning, and recommendations for the future. It is often a lengthy document laden with psychological terms and numerical test scores. Most psychological reports include the following sections:
Overview of Assessments Given
History – a detailed overview of developmental, social, treatment, medical, family and educational history
In-Person Observations – an overall explanation of the time spent with the psychologist and their in-person observations
Test Findings – numerical scores and explanations of results for assessments of intelligence, learning capacity, mental health, social functioning, personality traits, and any other assessments administered
Summary and Diagnoses – explanation of functioning and how diagnoses contribute to current state
Recommendations – suggestions for future treatment goals, academic and/or vocational accommodations, and areas needing further assessment
After reviewing the report, which may require reading more than once, it is important to meet with the psychologist to review the results. Be prepared with questions, requested revisions if there are factual inaccuracies, or requests for further clarifications or additional information. The written report will be used for numerous purposes, and it is important that it is accurate and comprehensible.
Some psychologists may provide a truncated report for use in academic and/or professional settings. These reports often give a less personal summary along with diagnostic codes and doctor recommended accommodations. This allows individuals to apply for support while maintaining personal privacy. If you require this type of report, it is best to discuss the option prior to the day of testing.
Utilize the Report
The final psychological report is a useful tool that has many benefits, including personal elucidation. However hard it is to accept a diagnosis, there is a benefit to knowing if you or a loved one has an ASD or another disorder. Knowledge is the necessary first step in planning for the future. The report is helpful in advocating for accommodations and assistance at school or work. You can also use the report in applying for any benefits that may be available, such as disability or an IEP (Individualized Education Plan) at school. The report will also be useful for your therapist and other mental health providers so that they can provide appropriate support. The report can and should be used as a tool to gain as much support and guidance as possible.
Personal Responses to the Content of the Report
The results contained in a psychological assessment report are not always easy reading and it is common to disagree with or dislike the findings. This is a natural response and one you should feel comfortable discussing with the testing psychologist to ensure you fully understand the results, what they are based on and what they mean. In the event a second opinion is obtained, it is important to recognize some tests can be administered multiple times, while others have test-retest validity issues. This means that the assessment cannot reliably be readministered for a specific time after the first test. Repeated testing searching for a different outcome is not advised.
Finally, it is important to remain mindful that any psychological report is a “snapshot” of a moment in time. Although psychologists are trained to gather and assess information in a way that is diagnostic and predictive, they do not have a crystal ball and cannot determine exactly what the future will hold. Thus, psychological reports are an evidence-based evaluation of the current situation and its trajectory, they do not guarantee any single future path.
Summary
Psychological testing provides critical information and direction for mental health care. To derive the most value, the testing should be done by a properly trained psychologist and the subject should fully engage in the process by asking questions where necessary and providing complete and accurate information. Once completed, the testing results may allow for academic and vocational accommodations, disability support, and critical direction for future psychological care.
Psychological Testing Toolkit
