What to Expect from an Autism Assessment

By Rachel Fenning, PhD, assistant clinical professor at The Center for Autism & Neurodevelopmental Disorders

The experience of having a child evaluated for a developmental concern may feel overwhelming, but the assessment process can provide clarity and guidance. If your child does receive a diagnosis of autism spectrum disorder (ASD), the assessment represents a vital first step in securing important treatments for your child.

A diagnosis of ASD is based on direct assessment of the child and clinical information gathered from key individuals in the child’s life. A physician or clinical psychologist typically performs the initial diagnostic evaluation, which may include:

• A complete history, including a detailed interview about your child’s current and past experiences and behaviors.

You will be asked to recall specifics about your child’s history. Many families find it useful to reference their child’s baby book or other notes. For instance, creating a timeline of events, including developmental milestones, behavioral changes, and the emergence of any concerns may be helpful. It is also important to be prepared to talk about family medical history, too.

• Careful observation and interaction with your child during the appointment.

Many professionals use specific tools to evaluate symptoms of ASD. The Autism Diagnostic Observation Schedule-2 (ADOS-2) is among the most widely used and most respected instruments. However, results from any diagnostic tool should  always be used in combination with other information to inform clinical decisions.

Many experts further recommend a multi-disciplinary assessment approach in order to better understand a child’s functioning and to guide recommendations. This may include several visits with different specialists. You should feel comfortable inquiring about the need for any or all the following:

• A thorough medical assessment, including a general physical and neurological exam, hearing and vision testing, and laboratory testing.

• A psychological assessment, including measures of cognitive functioning, social-emotional skills and adaptive behavior, and possibly academic skills.

• A speech and language assessment, including tests of language comprehension, expression, and everyday language use.

• An occupational or physical therapy assessment, including measures of motor functioning and sensory processing.

Depending on the assessment results, your provider may suggest a range of possible interventions, such as intensive behavior intervention (applied behavior analysis), counseling, speech and language therapy, educational interventions, occupational and physical therapy, and related supports. You will have an opportunity to ask questions, and it may help to have a few in mind ahead of time. It is also important to establish ways to follow up with your provider about any future concerns.

Finally, know that by engaging in the assessment process, you are taking an important step toward gaining understanding and support for you and your child.

Learn more about CHOC’s partner, The Center for Autism & Neurodevelopmental Disorders.

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Understanding Your Autistic Child

girl with balloonsHELPING FAMILIES COPE
“A most important initial step to understanding your child is by obtaining the best comprehensive evaluation, identifying the child’s strengths and weaknesses, having questions answered, and developing a plan for intervention,” says Dr. Donnelly, pediatric neurologist at CHOC and UC Irvine. “Parents and families need help and hope. They need to believe their child will improve and has a chance for a meaningful life. They can get help by contacting The Center for Autism & Neurodevelopmental Disorders in Santa Ana.”

“The main and most evidenced-based treatment is behavioral intervention, or Applied Behavioral Analysis (ABA),” Dr. Donnelly says. “ABA is a method of analyzing behavior using certain principles to create a plan to change behavior using specific rewards and punishments, to facilitate social  interaction and communication, and eliminate negative behaviors. Other treatments can include special education programs, speech and language therapy, social skills groups, and occupational therapy. Medical evaluation and treatment focuses on making accurate diagnoses, determining etiology, supporting and educating the family, providing genetic information, treating any related problems, like seizures, and pinpointing associated behaviors such as ADHD, anxiety or aggression, and supporting behavioral strategies or medication to help improve symptoms.”

It’s important for parents and families to be engaged with their child, says Dr. Donnelly. “Speak and play with your child and learn how to be their most important mentor. Get to know them and how they learn best. Identify their strengths and weaknesses and learn how to facilitate their social communication skills and behavior. Become a lay expert in behavior intervention. Have an optimistic but realistic outlook.”

“Autism spectrum disorder (ASD), as it is now called, encompasses autism and what was previously called Asperger syndrome,” says Dr. Donnelly. “ASD is a neurodevelopmental disorder characterized by key behavioral features, including significant impairment in social communication and restricted and repetitive behaviors. The term “spectrum” is useful not only to describe a large group of varied individuals, but it also signifies a wide difference in the type and severity of specific behaviors. Symptoms can include things like poor social skills, atypical language, sensory issues, motor impairment and developmental delays.”


  • Percentage of National Institute of Health Research funds allocated to autism research annually: Less than 5 %
  • Prevalence of Autism Spectrum Disorder in children overall: 1 in 88
  • Prevalence of Autism Spectrum Disorder in boys: 1 in 54

View the full feature on Kids and Understanding Autism

Dr. Joseph H. Donnelly
Dr. Joseph H. Donnelly
CHOC and UC Irvine Pediatric Neurologist


Dr. Donnelly is the medical director of The Center for Autism & Neurodevelopmental Disorders located in Santa Ana, a partnership between CHOC Children’s, UC Irvine School of Medicine and Chapman College of Educational Studies. He completed an internship and residency in pediatrics at Boston City Hospital, and a fellowship in pediatric neurology at the Boston City Hospital-Boston University and Harvard University Neurology units. Dr. Donnelly specializes in child neurology and neurodevelopmental disorders such as autism, attention deficit hyperactivity disorder (ADHD) and other developmental disabilities.

Dr. Donnelly’s philosophy of care: “The secret of caring for the patient is “to care” for the patient (as first said by surgeon Francis Peabody in 1912 at a graduation of medical students). In order to care for a child, one must relate to the entire family and develop a trusting relationship where the physician and health care team helps support, educate and guide the family.”

Harvard College
Georgetown University School of Medicine, Washington D.C.

Pediatrics Neurology with special qualification in child neurology

More about Dr. Donnelly

This article was featured in the Orange County Register on March 20, 2014, and was written by Amy Bentley.

Signs, Myths of Autism Spectrum Disorder

Autism_baby_smallerAutism Spectrum Disorder remains a mysterious but prevalent disorder that now is believed to affect one in 88 children and one in 54 boys in the United States. It’s also the fastest-growing serious developmental disability in the country.

There is no medical detection or cure for autism. However, learning as much as possible about the condition helps families understand and better assist their child with autism, says Dr. Joseph H. Donnelly, a CHOC neurologist and the medical director of The Center for Autism & Neurodevelopmental Disorders.

“The most obvious signs of autism emerge between 12 and 18 months of age,” says Dr. Donnelly.

Here are some signs that may indicate your child is at risk for an autism spectrum disorder:

  • No big smiles or other warm, joyful expressions by 6 months of age or older
  • No back-and-forth sharing of sounds, smiles or other facial expressions by 9 months
  • No babbling by 12 months
  • No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
  • No words by 16 months
  • No meaningful, two-word phrases (not including imitating or repeating) by 24 months
  • Any loss of speech, babbling or social skills at any age

Parents of children showing these symptoms should ask their pediatrician for an immediate evaluation, advises Dr. Donnelly.

It’s a myth that children with autism lack strengths, says Dr. Donnelly. In fact, people with autism can have significant strengths and sometimes perform better, or are more capable, in certain areas than typical children.

“Never assume a child cannot do something. Try everything and discover a child’s strengths, weaknesses and learning style.” he says. “Children with autism can have learning disabilities like a typical child and this needs to be addressed the same way as with any child.”

Here are some other common myths about autism:

  • All children with autism don’t speak.
  • Children with autism all have an intellectual disability.
  • Autism is an emotional disorder.
  • People with autism don’t exhibit emotions.
  • People with autism can’t lead a meaningful life.

Common medical problems associated with autism include seizures, gastrointestinal problems, allergies and sleep difficulties, Dr. Donnelly says. Autism is often associated with varied behavioral problems like attention deficit hyperactivity disorder, anxiety and obsessive-compulsive disorders.

“Treatment is available.  Seek help from your pediatrician or someone with expertise in autism,” advises Dr. Donnelly.

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