Research Roadmap: What Should Autism Assessment Look Like in 2025?
Monday, December 23, 2024
Every year, autism research yields an enormous amount of information about the causes and characteristics of the condition. As more autistic people design and contribute to research, we’re also learning what it’s like to undergo an autism evaluation from their perspective. Below, you’ll find a quick recap of some of 2024’s studies—especially those that could influence how we conduct autism assessments in the coming year.
Should we use AI and other new technologies to identify autism?
No single tool or test, on its own, can identify autism in a child or an adult. Emerging technologies like eye-movement sensors and machine learning algorithms are promising, and they may soon be part of a holistic autism evaluation. In fact, some technologies are already FDA-approved for inclusion in autism evaluations. But researchers agree that to support the whole child, data needs to be gathered by a multidisciplinary team using multiple sources of information and validated instruments (Jones et al., 2024).
Learn more about autism assessments here.
Should we focus on making the process more neurodiversity-affirming?
It can be challenging to avoid deficit-focused language when conducting an evaluation to identify autism. That’s chiefly owing to the nature of the diagnostic criteria themselves. In a 2024 study that explored the diagnostic experience of autistic adults, researchers said “the current dominance of the medical paradigm presents significant barriers for professionals to provide positive, neurodiversity-affirmative assessment experiences for autistic people” (Pritchard-Rowe et al., 2024).
To balance deficit-focused language and create a more positive experience, these researchers recommend the following strategies:
- Consider whether a play-based assessment is right for the individual.
- Validate and center the perspective of the individual.
- Identify, write about, and talk about strengths and assets.
- Rephrase or re-frame deficit-based language.
- Anticipate the possibility of masking or camouflaging, especially in women and girls.
- Avoid a one-size-fits-all assessment strategy.
Learn more about designing a neurodiversity-affirming evaluation here.
What co-occurring conditions should we consider?
For some time, clinicians and researchers have recognized that autism frequently co-occurs with several other health and neurodevelopmental conditions. Recent research confirms the need to consider testing or assessing for these conditions:
- attention-deficit hyperactivity disorder (Ostrowski et al., 2024)
- anxiety (Zoltowski et al., 2024)
- sleep disturbance and disorders (Taylor et al., 2024)
- depression (Salloum-Asfar et al., 2024)
- intellectual disability
- epilepsy (Capal & Jeste, 2024)
In a 2024 article published in the British Journal of Psychiatry, researchers Zavlis and Tyrer discussed the overlap of autism and borderline personality disorder (BPD). They noted that autistic individuals are sometimes misdiagnosed with BPD initially, and that BPD sometimes co-occurs with autism (Zavlis & Tyrer, 2024).
The differential diagnosis process will vary widely depending on both the individual's characteristics and their own personal priorities.
Learn more about whole child assessment here.
Should we assess for sensory processing differences?
People respond to sensory stimuli in their environments with different levels of sensitivity. Researchers think that differences in interoception (the ability to notice and accurately interpret sensory information within the body) may play a role in higher levels of anxiety in autistic people (Zoltowski et al., 2024).
Because over- and under-responsiveness to sensory stimuli are included in the diagnostic criteria for autism, it’s a good idea to learn more about the specific sensory responses of the person you’re evaluating. Understanding sensory needs can also help you recommend changes to the home and class environments that could prevent extra stress and behavior responses.
Learn more about assessing sensory processing with the Sensory Processing Measure, Second Edition (SPM™-2).
Should we screen for motor difficulties?
Yes. Autism often involves developmental motor differences. Some researchers say as many as 86.9% of autistic children have motor difficulties; in more than 35% of them, the difficulties will still be present in the teen years (Bhat, 2020). In some children, researchers say, these differences arise from a “unique motor phenotype” of autism. In other autistic children, developmental coordination disorder is a co-occurring condition. Because there’s so much overlap between autism and motor difficulties, researchers urge clinicians to screen for motor problems early in an autism evaluation (Miller et al., 2024).
Learn more about assessing early development, including motor skills, here.
Should we evaluate functional or adaptive behaviors?
In November 2024, the U.S. Department of Education issued new guidance to support students with challenging behaviors. The Department’s “Dear Colleague” letter urges schools to conduct functional behavior assessments (FBAs) whenever they are needed to “support any student whose behavior interferes with learning.”
For autistic students with sensory differences or greater support needs, challenging behaviors may be a means of coping with or communicating unmet needs. “By using FBAs,” the Department writes, “educators can gain a better understanding of a student’s needs by identifying factors that contribute to the behavior’s occurrence” so they can “create more inclusive, developmental and educational experiences, without having to resort to removals from the classroom” (U.S. Department of Education, 2024).
Learn more about assessing adaptive behaviors using the Adaptive Behavior Assessment System, Third Edition (ABAS®-3).
Hone your FBA writing skills with professional development from WPS ProLearn™.
Should we measure IQ?
Autism and intellectual disability are not the same thing. Autism occurs in people of vastly different cognitive abilities, and IQ tests are not meant to be used to identify autism.
A meta-analysis published in 2024 looked at 18 studies involving a total of 1,842 neurodivergent participants. The goal was to find out whether researchers had identified a common cognitive profile among people with autism or ADHD. Here’s what the research showed: On Weschler intelligence tests, study participants had verbal and nonverbal reasoning scores in the average range. Their scores on working memory tasks were slightly lower, and on average, their processing speed scores were “more significantly reduced”—below the 25th percentile (Wilson, 2024).
Perhaps unsurprisingly, researchers noted that there was quite a lot of variability in how people performed from study to study.
What role should the family play in the evaluation process?
In a 2024 article published in Pediatric Annals, pediatrician L. A. Alkureishi described the role of the family this way: “They are the experts for their child and for their family. They know what routines work well and which do not. They can advise (and assist you) on how to conduct an examination with minimal stress.” She encouraged practitioners to have “respect for the tremendous experience that the family brings to the table” (Alkureishi & Hageman, 2024).
Key Messages
Autism evaluations require a holistic, family-centered approach. Recent research has shed more light on diagnostic options and co-occurring conditions, helping clinicians make more informed decisions about how best to support autistic individuals in reaching their own goals. As greater numbers of autistic individuals share their lived experience, research continues to expand what we know about autism, and the evaluation process can become more sensitive and effective.
Research and Resources:
Alkureishi, L. A. & Hageman, J. (2024). Caring for children with autism. Pediatric Annals 53(1): e1-e2. https://journals.healio.com/doi/10.3928/19382359-20231204-01
Bhat A. N. (2020). Is motor impairment in autism spectrum disorder distinct from developmental doordination disorder? A report from the SPARK study. Physical Therapy, 100(4), 633–644. https://doi.org/10.1093/ptj/pzz190
Capal, J. K., & Jeste, S. S. (2024). Autism and epilepsy. Pediatric Clinics of North America, 71(2), 241–252. https://doi.org/10.1016/j.pcl.2024.01.004
Jones, W., Klaiman, C., & Klin, A. (2024). Diagnosis of autism-Reply. JAMA, 331(3), 259–260. https://doi.org/10.1001/jama.2023.24158
Miller, H. L., Licari, M. K., Bhat, A., Aziz-Zadeh, L. S., Van Damme, T., Fears, N. E., Cermak, S. A., & Tamplain, P. M. (2024). Motor problems in autism: Co-occurrence or feature? Developmental medicine and child neurology, 66(1), 16–22. https://doi.org/10.1111/dmcn.15674
Ostrowski, J., Religioni, U., Gellert, B., Sytnik-Czetwertyński, J., & Pinkas, J. (2024). Autism spectrum disorders: Etiology, epidemiology, and challenges for public health. Medical Science Monitor, 30, e944161. https://doi.org/10.12659/MSM.944161
Pritchard-Rowe, E., de Lemos, C., Howard, K., & Gibson, J. (2024). Autistic adults' perspectives and experiences of diagnostic assessments that include play across the lifespan. Autism, 13623613241257601. Advance online publication. https://doi.org/10.1177/13623613241257601
Salloum-Asfar, S., Zawia, N., & Abdulla, S. A. (2024). Retracing our steps: A review on autism research in children, its limitation and impending pharmacological interventions. Pharmacology & Therapeutics, 253, 108564. https://doi.org/10.1016/j.pharmthera.2023.108564
Taylor, B. J., Pedersen, K. A., Mazefsky, C. A., Lamy, M. A., Reynolds, C. F., 3rd, Strathmann, W. R., & Siegel, M. (2024). From alert child to sleepy adolescent: Age trends in chronotype, social jetlag, and sleep problems in youth with autism. Journal of Autism and Developmental Disorders, 54(12), 4529–4539. https://doi.org/10.1007/s10803-023-06187-0
U.S. Department of Education. (2024, November). Using functional behavioral assessments to create supportive learning environments. https://sites.ed.gov/idea/idea-files/using-functional-behavioral-assessments-to-create-supportive-learning-environments/
Wilson A. C. (2024). Cognitive profile in autism and ADHD: A meta-analysis of performance on the WAIS-IV and WISC-V. Archives of Clinical Neuropsychology, 39(4), 498–515. https://doi.org/10.1093/arclin/acad073
Zavlis, O., & Tyrer, P. (2024). The interface of autism and (borderline) personality disorder. The British Journal of Psychiatry, 225(3), 360–361. https://doi.org/10.1192/bjp.2024.80
Zoltowski, A. R., Convery, C. A., Eyoh, E., Plump, E., Sullivan, M., Arumalla, E. R., Quinde-Zlibut, J. M., Keceli-Kaysili, B., Lewis, B., & Cascio, C. J. (2024). Sensory processing and anxiety: Within and beyond the autism spectrum. Current Topics in Behavioral Neurosciences, 10.1007/7854_2024_557. Advance online publication. https://doi.org/10.1007/7854_2024_557