Select tools for the diagnosis of autism spectrum disorder

Diagnostic instrument	Age	Description	Comments
Autism Diagnostic Interview–Revised	Mental age ≥18 months	Two- to 3-hour clinical interview that probes for ASD symptoms	Not practical for clinical settings Usually used in research settings, often combined with the ADOS-2
Autism Diagnostic Observation Schedule–Second edition	Age 12 months through adulthood	Semistructured assessment by trained clinician of: Social interaction Play/imaginative use of materials Communication Atypical behaviors Five modules based on child's expressive language abilities (including one for toddlers) Takes 40 to 60 minutes to administer	Reference standard for diagnosis of ASD in research studies and in many clinical settings
Childhood Autism Rating Scale–Second edition (standard version)	Children ≥2 years of age	15 items directly observed by a trained clinician Can be completed by clinicians, parents, or teachers Takes 20 to 30 minutes to administer	15 items are correlated with DSM-IV
Developmental, Dimensional, and Diagnostic Interview	≥3 years of age	Computerized parental interview 266 questions related to ASD 291 questions related to comorbid mental health conditions Measures intensity of ASD symptoms and comorbidities Takes 2 hours to administer	Predominantly used outside the United States
Diagnostic Interview for Social and Communication Disorder	Any age	Detailed semistructured interview with informant who knows patient well, ideally from infancy Collects information on core symptoms of ASD and symptoms in other domains (eg, sensory, emotional, maladaptive behaviors) Takes 3 hours to administer	Predominantly used outside the United States
Gilliam Autism Rating Scale–Third edition	Age 2 to 22 years	Checklist of 56 items based on DSM-5 criteria with subscales for: Restrictive/repetitive behaviors Social interaction Social communication Emotional responses Cognitive style Maladaptive speech Completed by parents Takes 5 to 10 minutes to administer
Instrument for higher-functioning children
Asperger Syndrome Diagnostic Scale	Age 5 to 18 years	50 yes/no items in the following areas: Cognitive Maladaptive Language Social Sensorimotor Completed by parents, teachers, therapists, or other professionals Takes 10 to 15 minutes to administer
Childhood Autism Rating Scale–Second edition (high-functioning version)	Children ≥2 years of age	15 items directly observed by a trained clinician Can be completed by clinicians, parents, or teachers Takes 20 to 30 minutes to administer	15 items are correlated with DSM-IV

These tools are recommended in national guidelines; they should be used in conjunction with clinical judgment. Their diagnostic accuracy has not been widely studied.

ASD: autism spectrum disorder; ADOS-2: Autism Diagnostic Observation Schedule–Second edition; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders–Fourth edition; DSM-5: Diagnostic and Statistical Manual of Mental Disorders–Fifth edition.

Data from:

Randall M, Egberts KJ, Samtani A, et al. Diagnostic tests for autism spectrum disorder (ASD) in preschool children. Cochrane Database Syst Rev 2018; 7:CD009044.
Skuse D. Developmental, Dimensional and Diagnostic Interview. Institute of Child Health, London 2013.
Leekam S. Diagnostic Interview for Social and Communication Disorders. Springer-Verlag Heidelberg, 2012.

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Select tools for the diagnosis of autism spectrum disorder