The ADI-R and Other Tests Used to Make an Autism Diagnosis

The ADI-R is one of several important tests used to diagnose autism.

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The Autism Diagnostic Interview-Revised, better known as the ADI-R, is a set of interview questions that are administered to the parents of young children with possible symptoms of autism or an autism spectrum disorder. The questions should take about 90 minutes or so to administer.

What exactly is the ADI-R?

The interview contains 93 items and focuses on behaviors in three content areas or domains: quality of social interaction (e.g., emotional sharing, offering and seeking comfort, social smiling and responding to other children); communication and language (e.g., stereotyped utterances, pronoun reversal, social usage of language); and repetitive, restricted and stereotyped interests and behavior (e.g., unusual preoccupations, hand and finger mannerisms, unusual sensory interests). The measure also includes other items relevant for treatment planning, such as self-injury and over-activity.

The test asks both general and specific questions. For example, parents are asked about their child's communication abilities with special reference to topics such as pointing, head nodding, and so forth. Both verbal and non-verbal communication and social skills are scored, with reference to the child's chronological age. Scores are generated in the areas of communication and language, social interaction, and restricted or repetitive behaviors. A higher score indicates a potential developmental delay. According to AGRE:

A classification of autism is given when scores in all three content areas of communication, social interaction, and patterns of behavior meet or exceed the specified cutoffs, and onset of the disorder is evident by 36 months of age. ... The total cutoff score for the communication and language domain is 8 for verbal subjects and 7 for nonverbal subjects. For all subjects, the cutoff for the social interaction domain is 10, and the cutoff for restricted and repetitive behaviors is 3.

What Other Tests Should Be Used to Diagnose Autism?

Of course, the ADI-R should not be the only evaluation tool used to diagnose an autism spectrum diagnosis -- it's absolutely critical that a qualified expert examine your child personally. Tests often used to evaluate delays and symptoms in children themselves include the ADOS Autism Diagnostic Observation Scale and The Checklist for Autism In Toddlers (CHAT).

Ideally, in fact, an autism diagnosis should involve not a single individual but a team. Members of the team should include a pediatrician (ideally an individual with a specialty in developmental disorders), a psychologist, a speech and language pathologist, and an occupational therapist. These specialists can conduct a range of assessments that look for specific types of challenges and behaviors that would indicate autism (as opposed to or in addition to other, related disorders such as ADHD, Obsessive Compulsive Disorder, social anxiety, or social communication disorder).

How To Set Up an Evaluation for Your Child

In most cases, you have a few options for evaluation. You may choose to start with your pediatrician, who may be able to recommend an autism clinic or center where your child can be evaluated. You may also choose to work through your school district. The district is required to pay for certain evaluations, and can provide non-medical experts such as a speech-language pathologist and occupational therapist to assess your child.  It's important to bear in mind, however, that independent assessments may be useful as you begin to work with the school to develop an educational and therapeutic plan.

View Article Sources
  • Resources:
  • S. Ozonoff, S., B. L. Goodlin-Jones, et al. "Evidence-based assessment of autism spectrum disorders in children and adolescents." Journal of Clinical Child and Adolescent Psychology 34(3): 523-540, 2005.
  • Anne Le Couteur, Catherine Lord, Michael Rutter. Autism Diagnostic Interview-Revised (ADI-R), Western Psychological Services, 2003