The diagnosis of an autism spectrum disorder (ASD) in adults can be challenging. It is not uncommon for screening methods, clinical observation, and history to present a different picture. For clinicians, the question arises: Which finding should be given more weight?
A screening is not a diagnosis
Screening instruments like the AQ or the RAADS-R can provide an important initial indication of autistic traits. However, they are not intended to replace clinical diagnostics. Even a notable score is therefore initially a reason for further investigation.
Conversely, an unremarkable screening does not automatically mean that no ASD is present. Especially in adults, autistic traits may be less clearly visible due to compensation and adaptation strategies. The so-called camouflaging can lead to social difficulties being less noticeable outwardly.
What to do in case of contradictory findings?
The key is to combine various sources of information. In addition to standardized methods, the developmental history, current functional impairments, and clinical observation should be particularly considered. If possible, information from relatives or other biographical documents can also be included.
No single source of information should be regarded as the sole "gold standard." A high screening value can also be influenced by other psychological stressors. Similarly, an unremarkable clinical situation in a highly compensating person may not reflect the entire developmental history.
The clinical overall assessment remains crucial
Conflicting findings are therefore not necessarily a problem of diagnostics; they can themselves represent important diagnostic information. The central question is not which test is "correct," but how the different findings should be classified in the context of the diagnostic criteria and the individual developmental history.
A careful ASD diagnosis therefore combines standardized procedures with clinical expertise and a detailed developmental and medical history assessment. Especially in adults, this overview is crucial to avoid both over- and under-diagnosis.
Sources
AWMF: S3 guideline on autism spectrum disorders in children, youth, and adulthood – diagnostics.
Cook, J., Hull, L., Crane, L., & Mandy, W. (2021). Camouflaging in autism: A systematic review. Clinical psychology review, 89, 102080.