Autism Assessment

Autism is a neurodevelopmental difference that represents a natural variation in the way some people perceive and interact with the world, as well as process information (e.g., social and sensory information, etc.). Autism is an integral part of a person's identity. For more information about Autism, see the A.S.A.N. About Autism Page.

Research suggests that genetics plays a significant role. There have always been autistic people. Autism occurs across all racial, ethnic, and socio-economic backgrounds, and this highlights the diversity of autistic people.

Unfortunately, it is still important to debunk historical misinformation: Autism is not “caused” by parenting practices or vaccines, as extensive research has not supported this kind of stigmatising and harmful misinformation.

Prevalence rates of autism have been increasing in recent years, and this is thought to be due to increased awareness and diagnostic practices. As of 2023, it is estimated that 1 in 36 children in the United States are autistic. In Ireland, prevalence rates are 1-to-1.5% of the population. However, prevalence rates may vary by region and population.

Empirically supported traits of Autism can include the following:

Diverse Communication Styles: Autistic individuals may have diverse communication styles, preferences, and needs.

Intense Interests: Many autistic individuals have deep interests in specific subjects. These interests can become areas of expertise.

Sensory Processing Differences: Autistic individuals often have unique sensory experiences (e.g., heightened sensory processing, sensory preferences, etc.). Understanding and accommodating sensory processing differences supports well-being and comfort.

Individualised Learning Styles: Autistic children often have individualised learning styles that benefit from tailored approaches. Recognising and accommodating these different learning needs can enhance the educational experience.

Appreciation for Routine and Predictability: A preference for routine and predictability is often cited as an autistic trait. Routine can be a source of comfort and security for autistic individuals. Understanding and respecting these needs can promote well-being.

Different Social Engagement Preferences: Autistic individuals may engage socially in their own unique ways. They might have different needs and preferences when connecting with others.

Focused Attention: Autistic individuals may demonstrate considerable focus and attention on specific tasks or activities, reflecting their capacity for deep concentration and thorough exploration.

Autism is a diverse spectrum, and autistic individuals have a wide range of strengths and abilities. Some strengths associated with autism, which are supported by research, include:

Attention to Detail: Some autistic individuals have strong attention to detail, which can be valuable in various fields such as science, engineering, and art (Plaisted et al. 1998).

Strong Memory: Some autistic individuals have excellent memory skills, particularly in areas of interest (Boucher and Lewis, 1992).

Dedication and Focus: Many autistic individuals can become deeply dedicated to their interests, demonstrating an exceptional level of focus and persistence (Mazefsky et al., 2013).

Analytical Thinking: Some autistic individuals have strong analytical and logical thinking skills. These abilities are valuable in scientific research, mathematics, computer programming, and other technical fields (Dawson et al., 2007).

Creative Expression: Some autistic individuals demonstrate unique and creative ways of thinking and expressing themselves. This creativity can be channeled into various forms of art, music, and innovation. Research has explored creative talents in autism, as seen in "The Creative Cognition Approach: Autism and the Creative Brain" by Pring (2013).

Honesty and Integrity: Some autistic individuals are known for their honesty and strong sense of ethics, which can be highly valued in personal and professional relationships. While not always discussed in research explicitly, these qualities are frequently reported.

Specialised Knowledge: Individuals with autism sometimes develop deep expertise in specific areas of interest. This specialisd knowledge can lead to contributions in niche fields. Research has examined the phenomenon of "hyperfocus" in autism, as discussed in "The Experience of Hyperfocus in Autistic Individuals: An Exploratory Study" by Hull et al. (2020).

Of course, it is important to note that these qualities are not universal among autistic individuals, and individual strengths vary widely.

Additionally, autistic individuals face various challenges as a near-minority in a world that was not constructed with their needs in mind. Autistic individuals are a highly heterogeneous group of people, and research continues to explore the diverse characteristics and experiences of autistic individuals.

Autism presents across all genders and backgrounds, but research suggests cisgender girls might present differently than cisgender autistic boys in certain ways, as follows:

Social Interaction: Autistic girls may imitate social behaviours, leading to the perception that they have a neurotypical social style. This "masking" behaviour can hide their social differences (Lai et al., 2017).

Autistic girls might develop intense interests in social topics, such as celebrities, fiction, or animals, which are typical for their age but are pursued with greater zeal and depth (Attwood, 2007).

Autistic girls often prefer to socialise in one-on-one settings rather than in groups, and their friendships are often characterised by a deep emotional connection (Kreiser & White, 2014).

Communication: While some cisgender autistic girls may have a rich vocabulary, they might struggle with the unspoken neurotypical "rules" of conversation, such as turn-taking or recognising non-literal language forms like sarcasm (Gould & Ashton-Smith, 2011).

Autistic girls’ speech might be more “formal,” and they may prefer not to engage in casual conversations or “small talk” (Attwood, 2007).

Stimming and Monotropism: Routines might be more subtle and even internalised, such as mental routines or specific ways of imagining things (Gould & Ashton-Smith, 2011).

Sensory Sensitivities: Like other autistic individuals, autistic girls may have sensory sensitivities, such as finding certain sounds too loud or clothing textures uncomfortable (Kern et al., 2007).

Co-occurring Presentations: Autistic girls might have a higher prevalence of internalised distress, including anxiety or depression, partially because of societal pressures and the effort of masking (Lai & Baron-Cohen, 2015).

Differences from cisgender autistic boys: While both autistic boys and girls may experience higher levels of bullying, autistic girls are more susceptible to relational aggression, such as friendship manipulation (Cridland et al., 2014).

The "double empathy problem" is a concept that challenges traditional assumptions about autism and empathy. It suggests that difficulties in social interaction between neurotypical and neurodivergent individuals are mutual, with both parties struggling to understand and connect with the other due to differences in their social and communication styles, preferences, and needs.

The term was coined by Damian Milton, an autistic researcher, in his paper titled "On the Ontological Status of Autism: The 'Double Empathy Problem'" published in 2012. The double empathy problem has gained recognition as a valuable perspective for understanding social interactions between neurodivergent and neurotypical individuals.

Monotropism is a theory proposed by autistic researcher Dinah Murray and her colleagues, which suggests that autistic individuals tend to focus their attention and cognitive resources on a single or a limited number of interests or stimuli at any given time. This focus on a "monotropic" system is seen as a natural cognitive style rather than a limitation. It suggests that autistic individuals often have an intense focus on their interests and are highly attuned to specific details, which can be a valuable cognitive trait.

Citation link:

Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism, and the diagnostic criteria for autism. Autism, 9(2), 139-156.

The Circle Model of autism is an alternative way of thinking about autism that moves away from the traditional Spectrum Model. While the Spectrum Model views autism as a linear spectrum on a single dimension, the Circle Model represents a more complex and multidimensional understanding of autism.

The Circle Model recognises that individuals can have varying combinations and degrees of autistic traits across different domains and acknowledges that each autistic individual's profile is different. This model emphasises the strengths and abilities of autistic individuals, as well as difficulties.

The Circle Model encourages a more nuanced understanding of autism, moving beyond rigid categorisations and acknowledging the full range of diversity within the autistic experience.

Here is a very good visual example of the Circle Model.

Traits associated with Social (Pragmatic) Communication Differences (S.C.D.) will always be considered as a differential diagnosis by the Clinical Psychologist at All Kinds of Minds. Essentially, S.C.D. individuals have a different way of processing social or pragmatic information, as well as different ways of communicating.

Comparisons with Autism

Similarities: Both autistic individuals and S.C.D. individuals have social communication differences.

Differences:Autism is characterised by a broader range of traits beyond social communication differences, includingrepetitive behaviours (e.g., stimming, echoed language, etc.), a monotropic cognitive style (e.g., deep interests that are remarkable in breadth and depth), and sensory processing differences.It is important to remember that while all autistic individuals will have a degree of social communication difference, not everyone with social communication differences is autistic.

Comparison with Language Disorder

Similarities: Both S.C.D. and language disorders involve challenges related to communication.

Differences: Language disorder primarily involves difficulties in the acquisition and use of language due to difficulties in understanding or producing vocabulary, sentence structure, and discourse. S.C.D., on the other hand, centres on difficulties in the social use of verbal and nonverbal communication. S.C.D. individuals typically have a clear understanding of language structure, but struggle specifically with the social application of language.

Many autistic individuals and advocates prefer not to use functioning labels (e.g., “high functioning” or “low functioning”) because these labels are overly simplistic, often inaccurate, and do not capture the complexity of autism.

Here are some reasons why functioning labels can be problematic:

Inaccurate Representation: Functioning labels, such as "high-functioning" or "low-functioning," are often based on a narrow set of criteria, typically related to language and intellectual abilities. They do not consider the wide range of strengths and challenges that autistic individuals may have across various domains, including sensory processing, social communication, and executive functioning.

Stigmatisation and Stereotyping: Functioning labels can perpetuate stereotypes and stigmatisation. For example, "high-functioning" labels may lead to the assumption that an autistic person does not face any challenges or require any accommodations, while "low-functioning" labels may lead to underestimating an individual's capabilities and potential.

Fluctuating Abilities: Autism is dynamic, and an individual's abilities can vary greatly from day to day or across different contexts. Functioning labels are static and do not account for this variability.

Impact on Services and Support: Functioning labels can influence the types of services and supports that autistic individuals receive. Some may be denied essential support based on perceptions of being "high-functioning," while others may be denied opportunities for autonomy and independence based on perceptions of being "low-functioning."

Identity and Self-Esteem: Many autistic individuals prefer to define themselves based on their unique qualities, interests, and experiences rather than by functioning labels. These labels can impact self-esteem and identity, leading some individuals to feel marginalised.

It is more helpful to discuss specific support needs when discussing autism rather than using on functioning labels. Focusing on individual support needs helps avoid oversimplifications and assumptions about an individual's capabilities.

Emphasising support needs is central to person-centered planning, which involves collaborating with the individual to identify their goals, preferences, and the supports necessary to achieve them. Additionally, an individual's needs may change over time or in different situations. Focusing on support needs allows for flexibility in providing the right support at the right time.

Autism and A.D.H.D. share overlapping traits and characteristics, such as:

Executive Functioning Challenges: Both autistic individuals and “ADHDers” may experience difficulties with executive functions, which include skills like planning, organising, initiating tasks, and maintaining attention. These challenges can impact daily life and academic or work performance (Zalewska, A., 2019). Executive functioning difficulties in ADHDers arise primarily from difficulties related to inhibitory control, working memory, task initiation, and attention regulation. Organisational difficulties, leading to challenges in structuring tasks or activities and often resulting in misplaced items or last-minute rushes, can occur. There can also be difficulty with time management, estimating how long a task will take, or perceiving the passage of time accurately.

Executive functioning challenges in autism are diverse, affecting processes such as cognitive flexibility, planning, and initiating actions. They can also be intertwined with social communication differences. Difficulties switching between tasks or adapting to changes in routine are common. While some autistic individuals may excel at detailed planning, others might struggle with organising tasks, foreseeing consequences, or sequencing actions. Challenges in starting tasks or activities, especially if they are not aligned with personal interests, can occur. Some autistic individuals may have difficulty holding and processing multiple pieces of information simultaneously, especially in dynamic social situations. A preference for routines or familiar environments may be associated with difficulties adapting to unexpected changes. Lastly, autistic individuals might focus on details rather than the overall context or “bigger picture.”

Sensory Processing Differences: Some ADHDers have sensory processing differences—but sensory processing differences are more strongly associated with autism. Sensory processing difficulties are a core feature of autism and are included in the diagnostic criteria for autism. For ADHDers, while these difficulties are prevalent, they are not a central diagnostic feature. Also, the range and depth of sensory sensitivities might be more diverse in autism, encompassing all sensory modalities. Individuals with sensory processing differences can be hypersensitive (i.e., they may seek to avoid certain sensory inputs, such as sound, light, or textures) and/or hyposensitive (i.e., they may seek out certain stimuli). Sensory sensitivities can influence individuals comfort in and response to various environments (Ben-Sasson, A. et.al., 2007).

Social Interaction Differences: Social challenges in ADHDers primarily stem from impulsivity, inattention, and hyperactivity. ADHDers might interrupt others, act before thinking, or struggle to wait their turn, leading to unintentional social faux pas amongst neurotypical peers. They might miss social cues because they are distracted or not paying close attention to social interactions. This can make them appear as if they're not listening or not interested in others. Also, restlessness or fidgeting can be perceived by neurotypical people as disruptive in group settings. There is often a desire to engage socially and make friends, but the ADHDers difficulties can make sustained positive interactions more challenging—especially with neurotypical peers. ADHDers often recognise and feel hurt when rejected or left out, but they might not always understand why their actions lead to these outcomes.

By contrast, social challenges for autistic children are related to inherent differences in understanding and interpreting social information. Autistic children might have difficulty interpreting body language, facial expressions, or tone of voice, and might use fewer non-verbal cues (e.g., gestures and facial expressions) when interacting with others. Predicting and understanding the behaviours, thoughts, or feelings of neurotypical peers can be challenging—and vice versa. (See the double empathy problem.) While some autistic children might be less aware of or concerned with peer perceptions, many recognise their social differences from neurotypical peers. These differences can land do lead to social misunderstandings with neurotypical peers (Johnston, K., et.al., 2015).

To summarise: The root of social difficulties for ADHDers is more tied to impulsivity, inattention, and hyperactivity—while, for autistic children, it is related to differences in understanding and navigating social interactions with neurotypical peers. The type of social miscues differs: Miscues for ADHDers might involve interrupting or not listening—whereas for autistic children, this might manifest as missing the nuances of a conversation with neurotypical peers or not understanding neurotypical social expectations. Awareness and desire for social connection might differ: ADHDers often actively seek peer connections despite challenges—while autistic children might have variable social motivation.

Emotional Regulation: Both autistic individuals and ADHDers can struggle with emotional regulation. ADHDers may experience difficulties in managing their emotions, leading to emotional meltdowns, burnout, etc. (Yerys, B. E., et. al., 2017). For ADHDers, emotion regulation difficulties are often linked to impulsivity and the challenges of inhibitory control. ADHDers might have rapid and strong emotional reactions to stimuli, often appearing to act without thinking. They might become frustrated, impatient, or irritated more quickly than others, often due to difficulties with waiting or experiencing setbacks. Emotional reactions can be intense, leading to difficulties regulating strong feelings of disappointment, excitement, or frustration, as well as difficulty calming down after becoming upset. ADHDers can experience challenges in shifting attention away from a distressing event or stimulus, which can prolong difficult emotional states.

For autistic children, emotion regulation difficulties are multifaceted, stemming from sensory sensitivities and social communication differences. Over-or-under-responsiveness to sensory input can trigger strong emotional responses. For instance, an unexpected loud noise might result in an intense fear or distress response. Difficulties being understood by neurotypical peers can lead to misinterpretations, potentially resulting in seemingly unexpected emotional responses in the autistic young person. Lastly, difficulties adapting to change or unexpected outcomes can cause anxiety or distress.

Hyperfocus vs Monotropic Interest Pursuit: A.D.H.D. is characterised by variable attention regulation. While distractibility is common, the opposite can also occur, leading to hyperfocus. Hyperfocus in ADHDers refers to an intense concentration on a specific task or activity, often to the exclusion of everything else. ADHDers might hyperfocus on various activities, from video games to work tasks. The subject of hyperfocus might change frequently. Hyperfocus in ADHDers often occurs when the individual is particularly interested or engaged in an activity; this contrasts with day-to-day tasks that might be difficult to focus on due to inattention. Many ADHDers describe using hyperfocus productively, especially in creative or work-related tasks, though it can also lead to imbalance when other responsibilities are neglected.

The term "hyperfocus" is less frequently used in the context of autism, but individuals with autism can exhibit intense concentration on specific interests or activities—and this is known as a monotropic approach to interests. Many people with autism have specific topics or activities, that they are passionate about; this can range from academic subjects to hobbies or even specific items or phenomena. Unlike the more variable nature of A.D.H.D. hyperfocus, the topics of intense concentration in autism tend to be more consistent over time. The focus on a passionately held interest or activity is not necessarily driven by external rewards but seems to be intrinsically motivating. Engaging in an interest can be comforting and a way to manage anxiety or overwhelming sensory input. Deep dives into these interests can lead to high levels of expertise or knowledge in specific areas (Tani, P., et. al., 2006).

Movement: Fidgeting for A.D.H.D. individuals refers to small and often restless movements, especially with the hands and feet. These can include tapping, bouncing, or shifting position frequently. ADHDers may fidget to help maintain attention. Fidgeting can act as a self-regulation mechanism to help them stay engaged in a task or situation. Fidgeting might increase during tasks requiring sustained attention or in situations where the ADHDer needs to stay still for extended periods.

By contrast, “repetitive behaviours,” often referred to as "stimming" (short for self-stimulatory behaviours), are behaviours or body movements that are done repeatedly. They can include hand-flapping, rocking, spinning, humming, flicking, etc. Like fidgeting in ADHDers, stimming can be a self-regulation mechanism. It can help manage overstimulation or understimulation, and help the autistic individual cope with anxiety or other emotions. Stimming can also provide pleasing sensory input or help modulate overwhelming sensory experiences. Stimming is often more consistent for the autistic individual compared to the variable fidgeting seen in ADHDers. Both fidgeting and stimming can be misinterpreted by neurotypical individuals, and it is important that neurodivergent children should not be deterred from fidgeting or stimming—unless, of course, the behaviour is causing harm.

There are many well-known autistic individuals who have openly discussed being autistic:

Greta Thunberg: The Swedish environmental activist Greta Thunberg, who gained global recognition for her efforts to combat climate change, has spoken openly about being autistic.

Daryl Hannah: The actress Daryl Hannah, known for her roles in films like "Blade Runner" and "Splash," has discussed her experiences being autistic.

Dan Aykroyd: The actor and comedian Dan Aykroyd, famous for his roles in "Ghostbusters" and "Blues Brothers," has spoken about being autistic. He has openly shared that his autism contributes to his interests in specific subjects, including law enforcement and paranormal phenomena.

Satoshi Tajiri: The creator of the Pokémon franchise, Satoshi Tajiri, has shared his journey as an autistic individual and how it influenced the development of Pokémon.

Haley Moss: Attorney and autism advocate Haley Moss, who became the first openly autistic lawyer in Florida, is known for her work promoting neurodiversity and inclusion.

Susan Boyle: The Scottish singer Susan Boyle, who gained fame through "Britain's Got Talent," has talked about being autistic and how music has been a source of expression.

John Elder Robison: An author, advocate, and neurodiversity activist, John Elder Robison has written about his experiences as an autistic individual in books like "Look Me in the Eye."

Chris Packham: A British naturalist and television presenter, Chris Packham has discussed being autistic and his passion for wildlife conservation.

Sir Anthony Hopkins: The renowned actor Sir Anthony Hopkins, known for his roles in films like "The Silence of the Lambs," revealed his late-in-life autism identification in interviews.

Temple Grandin: An accomplished author, speaker, and professor of animal science, Temple Grandin is one of the most well-known autistic individuals.

Ashley Storrie: A Scottish comedian and radio presenter. She is an advocate for autism awareness and often integrates her experiences as an autistic individual into her stand-up comedy, offering a humorous yet insightful perspective on neurodiversity.

Christine McGuinness: A model and television personality who was diagnosed after her children were diagnosed as autistic. She uses her platform to raise awareness about autism and neurodiversity in the UK.

Courtney Love: A musician and actress, Courtney Love is widely recognised for her role as the lead vocalist of the alternative rock band Hole.

Wentworth Miller: An actor known for his role in Prison Break, Wentworth Miller publicly discussed being autistic.

Fern Brady: A Scottish comedian, Fern Brady has been open about her experiences as an autistic woman. She incorporates these experiences into her stand-up routines, using humour to challenge misconceptions and promote greater awareness of neurodiversity.

Gary Numan: A musician and pioneer of electronic music, Gary Numan has had a profound influence on modern music. He was diagnosed as autistic later-in-life and credits his neurotype with shaping his creative process and unique sound.

Guy Martin: A British motorcycle racer and television presenter known for his engineering knowledge and passion for speed.

David Byrne: Best known as the lead singer and songwriter for the band Talking Heads, David Byrne is often associated with a distinctive style of performance and lyricism. In his book How Music Works, Byrne mentioned that he identifies with autistic traits.

Anthony Ianni: A former college basketball player and motivational speaker. Diagnosed as autistic at a young age, he became the first openly autistic player in N.C.A.A. Division I basketball.

Jim Eisenreich: A Major League Baseball player for teams like the Minnesota Twins and the Kansas City Royals and has become an advocate for neurodivergent individuals in sports.

Sam Holness: A triathlete who competes at the highest levels of endurance sports. He competes internationally in Ironman competitions and promotes inclusion in athletics.

Hannah Gadsby: An Australian comedian, Hannah Gadsby is known for her groundbreaking comedy specials, including Nanette, which blends humour with social commentary.

Clay Marzo: A professional surfer from Hawaii, Marzo is celebrated for his unique style and fluidity on the waves. Diagnosed with autism, Marzo has spoken about how his his autistic traits allow him to focus deeply on surfing, giving him an edge in competitions.