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Australia |
National Guideline for the assessment and diagnosis of autism in Australia (2023) |
Autism CRC |
1) Health practitioner (typically GP) makes a referral within the assessment and diagnostic process.
2) Comprehensive Needs Assessment
a. Assessment of functioning
3) Diagnostic evaluation (e.g. ADOS)
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The assessment can be done by either one professional (A) or through a multi-disciplinary team evaluation (B)
1) Lead Practitioner Diagnostic Evaluation: can be conducted by one or more relevant practitioners, which can be:
a. A paediatrician, a psychiatrist, a neurologist
b. A GP with at least 6 years of experience in the assessment and diagnosis of neurodevelopmental conditions
c. A psychologist specialised in clinical psychology, clinical neuropsychology, and/or educational/developmental psychology
2) Consensus Team Diagnostic Evaluation: should include at least one additional practitioner in addition to what’s been defined under lead practitioner, which can be:
a. A paediatrician, a psychiatrist, a neurologist
b. A GP with at least 6 years of experience in the assessment and diagnosis of neurodevelopmental conditions
c. A psychologist specialised in clinical psychology, clinical neuropsychology, and/or educational/developmental psychology
d. An occupational therapist
f. A registered nurse, which can be: a nurse practitioner, mental health nurse practitioner, or a registered nurse with relevant experience as a clinical nurse specialist/consultant
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DSM‑5‑TR (2022)
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ICD‑11 (2019)
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Canada |
Standards of diagnostic assessment for autism spectrum disorder (2019) |
Canadian Paediatric Society |
1) Children with suspected ASD are first identified by a paediatrician, family physician, parent, or another caregiver and then referred to a diagnostic assessment
2) ASD diagnostic assessment may include:
a. Developmental, medical, and social history
b. Information from school, childcare, community
c. Audiology, vision assessment
d. Direct clinical observation of the child
e. +/- ASD diagnostic tool, which can be a behavioural observation tool e.g. ADOS‑2, CARS‑2; and/or a questionnaire based on parent/caregiver interview e.g. ADI-R, SRS‑2, DISCO, 3di.
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In most provinces and territories only physicians or psychologists are licensed to diagnose ASD. In some communities, appropriately trained nurse practitioners may also make the diagnosis.
A. When a child’s symptoms clearly indicate ASD, an experienced or trained sole paediatric care provider can independently diagnose ASD (Approach 1).
B. Shared care model: when a child’s symptom presentation is milder, atypical, or complex, or a child is under 2 years of age, a paediatric care provider may use information from an ASD diagnostic assessment tool, and consult with another healthcare professional with specialised knowledge (e.g. a psychologist) to inform a diagnosis (Approach 2).
C. Team-based approach1: diagnostic assessment by healthcare professionals in an interdisciplinary or a multi-disciplinary team (Approach 3).
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Denmark |
National clinical guideline for the treatment of autism spectrum disorders in children and adolescents (2021) |
Danish Health Authority (Sundhedsstyrelsen) |
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Assessment for ASD is a specialist task and should include:
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Interview with primary caregivers, including information about early development, difficulties and co-morbid conditions.
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Observation of the child/young person’s environment and/or obtaining additional information from institutions (school, nursery, etc.)
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Autism-specific observation (ADOS) and parent interview (ADI-R)
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n/a |
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France |
Autism spectrum disorder: Warning signs, detection, diagnosis and assessment in children and adolescents – Best Practice Guideline (2018)
Instruction No. DGCS/SD3B/DGOS/SDR4/CNSA/2014/221 of 17 July 2014 on the national framework for detection, diagnosis and early interventions for children with autism or other pervasive developmental disorders provided for in the autism plan (2013‑2017) (2014) |
French Health Authority (Haute Autorité de santé, HAS) |
1) Screening is recommended in children with warning signs or who have a high risk of ASD (e.g. children born prematurely, siblings of children with ASD, etc.). Recommended tools for a comprehensive clinical assessment:
a. For children aged 16‑30 months: M-CHAT
b. For children aged 48 months and above: SCQ
c. In children and adolescent with co‑occurring intellectual developmental disorder: ASSQ, AQ and SRS‑2.
2) Referral: If the risk of ASD is confirmed during the dedicated screening consultation, the child should immediately be referred to a specialised neurodevelopmental disorders diagnostic consultation with a paediatric psychiatrist and/or a paediatrician.
3) Autism assessment should include at minimum the following:
a. Detailed developmental history
b. Standard screening tests (hearing, vision)
c. Complete clinical paediatric exam (weight, height, head circumference, neurological exam)
d. Clinical observation based on DSM‑5 criteria, which can be structured using tools, such as CARS, ADOS, ECA-R.
e. Language and communication assessment
g. Adaptive skills assessment
h. Psychomotor functions assessment
i. Sensory integration processes assessment
Diagnosis of co‑occurring conditions should also be considered. |
The diagnostic process should fall under a specialised local team, namely a second-line team comprised of professionals specifically trained in neurodevelopmental disorders and autism spectrum disorder:
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Paediatric psychiatry team (children’s psychiatry departments including medico-psychological centres – Centre medico-pédagogique, CMP)
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Paediatrics departments
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Centre for early medico-social action (CAMSP)
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Medico-psycho-pedagogical centres (Centre médico-psycho-pédagogique, CMPP)
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Networks of specialised care in the diagnosis and assessment of autism or private practitioners co‑ordinated by a doctor
For complex cases, consultation at a third-line facility is recommended, which can be:
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Professionals practicing at autism resource centres (CRA), or
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Professionals practicing at hospital centres for additional specialised opinions, namely in paediatric neurology, clinical genetics and medical imaging
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DSM‑5 (2013)
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Pending ICD‑11 (2019)
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Germany |
S32 Guideline on autism spectrum disorders in childhood, adolescence and adulthood (2016)3 |
Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) |
1) Screening is recommended in children with a pre‑defined risk factor (genetic findings with increased rate of ASD, drug exposure during pregnancy, viral infection during pregnancy, birth weight under 1500g, premature birth, neonatal seizures, siblings with ASD) and at least one additional symptom indicating ASD. Recommended tools for screening (optional):
b. For preschool and elementary school-aged children: SCQ
c. For primary school aged children and adolescents that are high-functioning: MBAS
d. For children and adolescents with intelligence impairment: SEAS-M
2) Referral to a centre specialising in autism spectrum disorder diagnostics should be made if clinically and ASD seems likely and/or parents/caregivers/affected person also report corresponding symptoms.
3) Diagnostic procedure should include:
a. Detailed medical history
b. Autism-specific diagnostic testing
i. A standardised instrument (interview with parent or guardian) should be used for clinically complex questions. The ADI-R is recommended for children.
ii. A semi-standardised behavioural observation should be conducted. Recommended instruments are CARS and ADOS‑2.
c. Assessment of cognitive abilities and skills
d. Assessment of strengths and weaknesses based on autism-specific diagnostic testing
e. Complete internal neurological examination
f. Assessment of hearing and visual disturbances
g. The presence of co-morbid disorders should be considered.
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The assessment should be conducted by one or more healthcare professionals who are knowledgeable and skilled in mental and developmental disorders, as well as in the screening instruments used and their evaluation and interpretation.
The diagnosis of children and adolescent should be made by a professional with the following competence:
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Skills in the use of specific diagnostic tools
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Differential diagnostic skills regarding all psychiatric and somatic co-morbidities
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Skills in performing an internal medicine‑neurology examination and correctly interpreting the results.
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Skills in the test psychological investigation of language development and cognitive development.
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Skills in professional counselling with regard to therapeutic, educational and social issues
The diagnosis should be made in consultation with:
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a specialist in child and adolescent psychiatry and psychotherapy, or
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a specialist in child and adolescent medicine who is specially qualified for this purpose
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ICD‑10 (1992)
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DSM-IV-TR (2000)
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DSM‑5 (2013)
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Israel |
Circular No. 15/13 of 10 November 2013, of the Director General of the Ministry of Health on diagnosing children on the autism spectrum (2013) |
Ministry of Health |
1) The diagnosis of a child with suspected autism should include a physical, neurological, developmental and emotional examination.
a. Developmental assessment using MULLEN or BAILEY-II/BAILEY-III until the age of 3.
b. Cognitive assessment using WPPSI-III between ages 3 and 7 and WISC-IV between ages 6 and 7.
c. Functional assessment using VINELAND-II or ABAS-II.
2) Assessment of autism symptoms using:
a. Parent questionnaires e.g. SRS‑2, SCW, CARS‑2
b. Kindergarten teacher/educator questionnaire e.g. SRS‑2
c. Also recommended: ADOS and ADI-R (if necessary and if the diagnosing professional is trained in their use)
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The diagnosis needs to be co-signed by at least two professionals:
1) A specialist conducting the physical, neurological, developmental and emotional assessment, i.e. one of the following:
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Child and adolescent psychiatrist
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Developmental paediatrician
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Child development specialist
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Expert in neurology and child development
2) A professional trained in autism diagnostic evaluation, i.e. one of the following:
a. Clinical psychologist with training in child or development psychology
b. Rehabilitation psychologist or education psychologist with training in autism diagnosis
Additional health professionals may also participate in the diagnosis if needed. |
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Netherlands |
Autism spectrum disorder in children/young people (2025) |
Dutch Association for Psychiatry (Nederlandse Vereniging voor Psychiatrie, NVvP) |
1) Information gathering (medical history) is recommended to gain full understanding of the child’s development and concerns, including information on:
a. Early development, including pre‑ and perinatal factor and course of development to date
b. Functioning of the child within the family
c. Previous diagnoses and interventions
d. Relevant family history
2) Combined with medical history, a physical examination is recommended to rule out underlying medical conditions, including:
a. Assessment of current and past physical health
b. Vision and hearing test
3) Developmental assessment may include:
a. General developmental test
4) Assessment of autistic traits should be done through:
a. Direct interaction with the child
b. Information collected from parents, teachers and caregivers
c. Behavioural observation
d. Observation of the child’s functioning in different settings
Recommended standardised tools can be used as support for the clinical diagnostic process, including:
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CARS, SCQ, AQ-child, SRS, VISK/CSBQ and ASV.
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For children with intellectual disability, the appropriate modules of ADOS/ADOS‑2 and ADI-R should be used.
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Diagnosis should be done by a specialist multi-disciplinary team.
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Behavioural observation should be done by a child psychiatrist, psychologist or developmental educationalist.
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Sweden |
National guidelines 2024: ADHD and autism |
National Board of Health
and Welfare (Socialstyrelsen) |
1) First line services offer early intervention for children and young people with suspected neuropsychiatric disorders.
2) Neuropsychiatric assessments are conducted focussing on either ADHD or autism, if healthcare or social services staff have a well-founded suspicion of a neuropsychiatric disability.
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A team with at least one doctor and one psychologist should complete the neuropsychiatric assessment and diagnosis. The following professionals should always be included:
The following professionals should be included in the assessment, as needed:
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Occupational therapist
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Speech therapist
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Physician with experience of addiction disorders
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Social worker
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Physiotherapist
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Special needs teacher
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Counsellor
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Dietitian
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Specialist nurse (e.g. midwife, paediatric nurse or psychiatric nurse)
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England (United
Kingdom) |
Autism spectrum disorder in under 19s: recognition, referral and diagnosis – Clinical guideline 128 (2017)
Autism spectrum disorder in under 19s: support and management – Clinical guideline 170 (2021) |
National Institute for Health and Care Excellence (NICE) |
1) Screening is recommended if there are concerns about the development, or behaviour of the child, and/or if there is an increased risk of autism e.g. sibling with autism, born prematurely, birth defects associated with central nervous system malformation, etc.
2) Referral is recommended:
a. To the “autism team” for children younger than 3 years, if there is a regression in language or social skills.
b. To a paediatrician or paediatric neurologist (who can refer to the “autism team” if necessary), if:
i. The child is older than 3 years, with regression in language
ii. A child has regression in motor skills
3) Diagnostic assessment should include:
a. Medical history, including prenatal and perinatal and family history
c. Information gathered from pre‑school or school, parents’ and carers’ about the child or young persons’ experiences of home life, education and social care
e. Assessment of social and communication skills and behaviours (using an autism-specific tool)
f. Consideration of differential diagnosis and systematic assessment for conditions that may coexist with ASD
g. Assessment of the child’s strengths, skills, impairment and needs
h. The following assessments should also be considered:
i. intellectual ability and learning style
iii. speech, language and communication skills
iv. fine and gross motor skills
v. adaptive behaviour (including self-help skills)
vi. mental and emotional health (including self-esteem)
vii. physical health and nutrition
viii. sensory sensitivities
ix. behaviour likely to affect day-to-day functioning and social participation
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A multi-disciplinary “autism team” composed of the following professionals:
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paediatrician or paediatric neurologist (core team)
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child and adolescent psychiatrist (core team)
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psychologist with training and experience in working with children and young people with autism (core team)
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psychologist with training and experience complementary to the psychologist in the core team
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speech and language therapist (core team)
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occupational therapist
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DSM‑5 (2013)
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ICD‑11 (2019)
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