Does My Child Need an Autism Assessment? How Psychologists Get Clarity (Including ADOS)
by Ho Shee Wai
Director/Registered Psychologist
Does My Child Need an Autism Assessment? How Psychologists Get Clarity (Including ADOS)
Most parents don’t wake up thinking, “I should get an autism assessment.” They wake up thinking, “Something doesn’t feel quite right.” Whether it’s delayed communication, emotional outbursts, or a child who seems bright but socially lost, many parents spend months wondering whether to wait or seek help. An autism assessment isn’t about rushing to a label — it’s about understanding how your child experiences the world and what support may help. In this article, psychologist Ho Shee Wai explains how Psychologists assess autism and where tools like ADOS fit in.
Johnny* is 2 years and 4 months old. His parents notice that while he began walking on time, his speech has been slower to develop. He uses a few single words inconsistently and often communicates by pulling his parents’ hands or pointing. When his name is called, he sometimes responds, but at other times appears not to notice, especially when focused on a toy. At playgroup, Johnny prefers to play alongside other children rather than with them. He may watch others closely but rarely joins in shared play. When another child approaches him, he sometimes walks away or becomes upset. His parents notice that he doesn’t often copy what other children are doing. Johnny enjoys certain activities intensely, such as spinning the wheels of toy cars or repeatedly opening and closing doors. He can become distressed if these activities are interrupted. Changes in routine — such as a different route home or a delayed meal — often lead to strong emotional reactions that are difficult to soothe. His parents also notice sensory sensitivities. Loud noises like vacuum cleaners or hand dryers cause him to cover his ears and cry. Certain food textures are strongly avoided, and dressing can be challenging due to sensitivity to clothing seams. Despite these concerns, Johnny shows moments of connection. He enjoys peek-a-boo with his father, seeks comfort from his mother when upset, and laughs during familiar games. These moments leave his parents feeling unsure:
“He connects with us — but something still feels different.”
After several months of watching and waiting, his parents decide to seek an assessment — not because they are certain something is wrong, but because they want clarity and guidance on how best to support him.
*Not his real name.
When Parents Start Wondering
Johnny’s story is not uncommon for many parents who sought assessment for their child. Usually by age 3, some children start showing signs and symptoms that cause the parents to start wondering. Even though many children get diagnosed early, there are children who don’t get diagnosed till later in the school life especially if they are on the borderline of the spectrum.
Common early concerns parents notice
Many parents don’t start with the word autism. They start with a feeling that something is not quite right, even when their child seems bright, loving, or capable. Here are some concerns that might suggest that your child might need an assessment.
Communication & Language
Parents may notice differences not just in how much their child speaks, but how they communicate.
Delayed speech or limited words compared to peers
Using language in unusual ways (repeating phrases, scripting)
Difficulty starting or maintaining conversations
Talking at others rather than with them
Literal understanding of language (missing jokes or sarcasm)
Social Interaction
Some children appear content on their own but find connecting with others confusing or effortful.
Limited eye contact or inconsistent eye contact
Preferring to play alone or alongside others rather than with them
Difficulty understanding social cues (turn-taking, facial expressions)
Appearing unaware of others’ emotions or intentions
Struggling to make or keep friendships
Social Reciprocity (the “back-and-forth”)
Parents may notice challenges in the natural give-and-take of interaction, even in everyday moments.
Not responding consistently when name is called
Limited sharing of interests, excitement, or achievements
Difficulty engaging in reciprocal play or conversation
Appearing socially withdrawn in groups, but more comfortable one-to-one
Behaviour & Flexibility
Some children rely heavily on predictability and repetition to feel safe and regulated.
Strong preference for routines or sameness
Distress with changes, even small ones
Repetitive behaviours (lining up toys, hand movements, repeating actions)
Intense or narrow interests that dominate play or conversation
Emotional Regulation
Big emotions can feel overwhelming and hard to manage for some children.
Frequent meltdowns or emotional outbursts
Difficulty calming down once upset
Appearing overwhelmed in busy or noisy environments
Seeming unusually anxious, rigid, or easily frustrated
Sensory Sensitivities
Parents may notice strong reactions to sensory input that others barely notice.
Strong reactions to sounds, textures, lights, or smells
Avoidance of certain foods or clothing
Seeking sensory input (spinning, crashing, touching objects repeatedly)
Uneven Development
Some children show advanced abilities in certain areas alongside unexpected challenges in others.
Advanced abilities in some areas (e.g. reading, memory, numbers)
Noticeable struggles in others (e.g. social skills, flexibility)
Teachers may say: “Very capable, but something is getting in the way.”
School-Related Concerns
Difficulties often become more noticeable in group or structured settings.
Coping academically but struggling socially
Exhaustion or meltdowns after school
Teachers raising concerns about social communication or behaviour
Masking at school, followed by emotional release at home
An Important Reassurance for Parents
Noticing some of these signs does not automatically mean autism. Many of these behaviours can overlap with:
Anxiety
ADHD
Language delay
Emotional stress
Personality differences
What matters is the pattern, persistence, and impact on daily life — which is why structured assessment can be helpful.
Why Many Parents Feel Unsure — and Why “Waiting and Seeing” Is So Hard
Why It’s Normal to Feel Unsure About Autism
Most parents are not professionally trained in children’s development, therefore they may or may not know whether their child is on track. There is also this belief of gender difference “Boys will speak later/less” which may lead the parents missing early signs. There is also a sense of denial that something may be wrong with my child and hope that eventually they will grow out of it.
Why “waiting and seeing” can feel tempting — and stressful
While it’s understandable that parents would want to take a “wait and see” approach in the hope that their child’s development would catch up with their same aged peers and some parents worried about labelling their child too early, what they may not realize is that in addition to the delay causing challenges and stress to them as a parents, it’s also causing frustration to the child who’s not receiving the appropriate support.
Why Early Support Can Make a Difference
The early intervention is important because the early years are when the brain is most flexible and responsive to support. Early intervention works with this natural brain plasticity, helping children build skills when change is easiest, rather than trying to undo difficulties later.
To be able to provide the correct intervention, we must first know what is happening with your child, before we can provide the appropriate support. This is where Autism Assessment comes in.
What an Autism Assessment Really Is (and Isn’t)
Not a single test
Some parents (and clinician) mistakenly think that there is a “Autism Test” and with this one test, we know whether your child is Autistic or no. The truth is, for a diagnosis of Autism, there are a battery of tests that the child (and the parents) needs to undergo.
Not based on one behaviour (or all the behaviours)
It’s easy to generalize – “he’s not making eye contact, he’s autistic”, “she doesn’t socialize, she’s autistic”. While a child does not need to have all the behavioural symptoms and signs to be diagnosed as autistic, we also cannot just pin point to some stereotypical behavior and make the conclusion that the child is autistic. Making a diagnosis for autism require holistic integration of your child’s behaviours.
Not about labelling a child’s future
Although after the assessment the Psychologist will provide a diagnosis, the purpose of that is not about labelling the child. The goals of assessment for autism (and other special needs) are to identify what challenges the child is facing, what support the child is requiring, what interventions or skills the child need, and what type of accommodation can level the playing field for the child. Many resources are only accessible after the child receive a diagnosis.
How Psychologist Assess Autism
Developmental history
The Psychologist conducting the assessment needs to take a thorough developmental and medical history of the child, starting from pregnancy, child birth to the current stage. Any difficulties and delay are important signal for the Psychologist to make the final diagnosis so it’s important that parents do not minimize something that happened because it’s in the past.
Parent interviews
The Psychologist will also interview the parents to get an understanding of the child’s behaviours in their daily life. Often times the parents would be asked to provide feedback in some standard forms so that no information will be missed out.
Behavioural observation
During the assessment session, the Psychologist will observe first hand the child’s behaviour while they undergo various tasks in order to make a decision in terms of where the child is at as compared to same aged peers.
Input from school (when relevant)
If the child is in school, the Psychologist will also seek for feedback, generally in some standard forms, in order to understand the teacher’s observation of how the child is behaving outside of the home setting.
Where ADOS Fits In
What ADOS stands for
ADOS (Autism Diagnostic Observation Schedule) is a "gold standard," semi-structured assessment tool used by clinicians to evaluate individuals for Autism Spectrum Disorder (ASD) by observing social communication, interaction, play, and restricted behaviors through standardized activities and conversation. It's a key part of a broader autism assessment, not a standalone diagnosis, using different modules (versions) for various ages and language levels, from toddlers to adults, to understand a person's social and communication strengths and challenges.
What it looks like for a child
ADOS is play-based, structured, supportive, so it is not stressful for the child.
What it can and cannot tell you
ADOS can provide valuable insight into patterns of social communication, play, and emotional reciprocity that may be associated with autism. However, ADOS does not diagnose autism on its own. It does not predict a child’s future, intelligence, or potential, and it cannot capture how a child behaves in every setting or relationship. ADOS results must always be understood alongside developmental history, parent input, observations across contexts, and clinical judgement. In this way, ADOS offers clarity about how a child is functioning in the moment — not a fixed label about who the child is or who they will become.
What Parents Gain from an ADOS Assessment — Even Without a Diagnosis
Clearer understanding of strengths and challenges
Guidance for school and home
Reduced self-doubt
A shared language with professionals
When It’s a Good Time to Consider ADOS
When concerns persist
When school raises questions
When progress feels stuck
When parents want clarity, not guesswork
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No. ADOS is a structured assessment tool used as part of a comprehensive evaluation. A diagnosis is made by integrating ADOS results with developmental history, observations, and clinical judgement.
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Many children who cope well academically still experience social or emotional challenges. ADOS can help clarify whether these differences are part of autism or something else.
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Yes. Parents often gain valuable insights into how their child communicates, relates, and manages emotions, which can guide next steps even without a diagnosis.
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ADOS is designed to be engaging and child-friendly. It uses structured activities and interaction rather than testing in the traditional sense.
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Waiting can sometimes increase uncertainty and stress. An psychological assessment can provide clarity and guidance, whether support is needed now or later.
If you’re unsure whether an autism assessment — including ADOS — would be helpful for your child, a consultation with an experienced psychologist can help clarify next steps. An assessment is not a commitment to a diagnosis; it’s a way to understand your child’s needs and strengths more clearly.