Assessment & diagnosis

The 2016 guideline named what is asked in assessment, for example current symptoms, development, education, hobbies and friendships, help so far and family history. At least one close person who has known you since childhood should be involved; documents such as school reports, nursery reports or doctors' letters also help. The absence of such documents does not necessarily prevent the diagnosis in adults.

In detail: Preparing for the assessment

According to the 2016 guideline, an autism diagnosis made before the age of two stays stable within the spectrum; where symptoms are clear, it should be made even then. For infancy there are no reliably established features for prediction. A diagnosis is also possible later, into adulthood.

In detail: Diagnosis in children: who, where, how?

From the second year of life, the 2016 guideline named, for example, little eye contact, rarely pointing to share something, little reaction to their own name, lack of pretend play and loss of skills already acquired. Such signs are not a diagnosis, and good eye contact does not rule out autism. If you are worried, talk to the paediatric practice. Parents' concerns should be taken seriously.

In detail: First signs in infants and toddlers

An autism assessment is not a single test but a process over several appointments. Professionals gather information from conversations about developmental history, reports from nursery, school or earlier treatment, behaviour observation, physical examination and autism-specific procedures. A central part is checking whether other causes explain the observations better. In the end there should be not only a diagnosis but also concrete recommendations.

In detail: How an autism assessment works

According to the 2016 guideline, the comprehensive assessment should take place in a centre specialised in autism. For children and adolescents, the diagnosis should be made with the involvement of a specialist in child and adolescent psychiatry or a specially qualified professional in child and adolescent medicine; for adults, with the involvement of a specialist in psychiatry and psychotherapy or in neurology and psychiatry.

In detail: Diagnosis in children: who, where, how?

This cannot be said in general; it depends on the centre and the region. The 2016 guideline named long waiting times for assessment appointments at specialised centres. We have not read current figures. Ask every centre about the waiting list and whether a referral is needed.

In detail: Referral, costs and waiting times

Screening questionnaires are not suitable for diagnosis but serve as an indication for further clarification; according to an expert overview, their specificity in the clinical context is low. The 2016 guideline stated that a diagnosis can neither be made nor ruled out on the basis of screening instruments, and named several questionnaires circulating on the internet as not supported by studies. For today's freely available online tests we have read no evaluation. A conspicuous result does not replace assessment; an inconspicuous one does not rule out autism.

In detail: Screening questionnaires and online tests: what they can and cannot do

Yes. Autism begins in the developmental period, but sometimes the features only become clear when life's demands increase. In principle, assessment follows the same path as for children; a particular challenge is reconstructing early development afterwards. According to an expert overview, asking relatives and looking at old documents help with this.

In detail: Assessment in adulthood

The 2016 guideline stated that, when the diagnosis is communicated, age-appropriate explanation of the condition should be given. It described detailed explanation, early planning of the help needed and a fixed contact person as helpful. According to the 2021 guideline, a diagnosis does not automatically mean that therapy is needed permanently.

In detail: After the diagnosis: first steps