In-Home Autism Assessments

Our clinician will carry out a structured but friendly assessment, including:

• A developmental history (with the individual and/or parent/carer)
• The ADOS-2 assessment (a play and / or conversation-based tool)
• Observations and informal discussion

We will take breaks as needed and move at a comfortable pace. The environment is kept calm, respectful, and person-centred.

Depending on age and needs, we may ask you to complete one or more brief questionnaires before the assessment (typically these are the age appropriate AQ, and the Monotropism Questionnaire). We will explain exactly what’s needed during your initial telephone consultation.

We use the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) – one of the most widely recognised and validated tools for identifying Autism across all ages and developmental levels.

The ADOS-2 is a play and conversation-based assessment that allows us to observe communication, social interaction, imagination, and behaviour in a supportive and structured setting.

There are five modules of the ADOS-2, and we select the most appropriate one based on the individual’s age and verbal abilities:

• Module 1 – For individuals with little or no phrase speech
• Module 2 – For those who use phrase speech but are not yet verbally fluent
• Module 3 – For verbally fluent children
• Module 4 – For verbally fluent adolescents and adults

The chosen module allows us to gather meaningful insights while ensuring the process is comfortable and age-appropriate.

While our standalone autism assessments focus on autism, we are highly experienced in recognising signs of co-occurring conditions such as:

• ADHD
• Learning Disability
• Anxiety and mood differences
• Sensory processing challenges

If we observe traits consistent with another neurotype during the assessment, we will:

• Note this in your report
• Provide thoughtful commentary on how these traits may be impacting day-to-day life
• Offer clear, tailored recommendations for further assessment or support.

Our goal is to see the whole person, not just a diagnosis, and to help you find clarity and direction, whatever your support needs may be.

No referral is required. You can self-refer at any time. However, we’re happy to collaborate with your GP, NHS professionals, or school.

For many people, a diagnosis brings relief, clarity, and a deeper understanding of themselves or their child. It can open doors to support, accommodations, and connection with others. We also provide practical recommendations for school, work or family settings based on the outcome.

Yes. Many autistic children compensate well in structured environments like school but struggle at home. We ask about how your child copes in both settings to build an accurate picture.

Yes. Our reports are detailed and professional, and are often used to support SEN provision, EHCP applications, University disability services, or workplace accommodations.

If the assessment does not indicate autism, we’ll still provide a detailed report outlining our observations and possible next steps for further support (e.g. ADHD, anxiety, trauma-informed care). We aim to make the process helpful regardless of the outcome.

Yes. We regularly assess teenagers and adults who may be seeking a diagnosis later in life. Our process takes into account masking, burnout, and social camouflaging, which are common among late-diagnosed autistic people (especially women and those from underrepresented backgrounds).

Preparation is simple! Generally, it’s useful to:

• Find a quiet, comfortable space at home for the clinician’s visit
• Gather any relevant reports, school records, or previous assessments if you have them
• Think about key developmental milestones and challenges you want to discuss
• Have favourite toys, books, or activities ready (especially for children)
• Talk with your child about the visit in a calm, positive way — reassuring them that the clinician is there to help and that there’s no ‘right’ or ‘wrong’ answer
• Complete any pre-assessment questionnaires we send

Feel free to ask us any questions before the day. We are here to support you every step of the way.

Waiting for assessment results can be a stressful time. Here are some things that might help:

• Keep a journal or notes on your experiences, feelings, and any questions you want to ask at the feedback session
• Reach out to peer support groups or local autism organisations for community and advice
• Consider self-help resources focusing on wellbeing, sensory needs, or social skills (we can recommend trusted materials)
• Maintain routines and strategies that support comfort and reduce anxiety
• Contact us anytime if you have urgent concerns or need guidance during the waiting period

Remember, the wait is temporary, and we’re committed to providing timely, thorough feedback to help you move forward with confidence

The current DSM – V criteria frames Autism as a deficit which can be hugely invalidating for anyone who is autistic. Framing Autism in a deficits focused way is incompatible with the neurodiversity movement and any neuro-affirming practices. A deficits focus frames Autism as something to be treated or cured rather than focusing on understanding, validation and changing the environment to meet unique needs.

A – A Preference for an autistic style of communication:

A 1. Preference for engaging and maintaining conversation with others predominantly based on individual interests, experiences and needs/ opinions or someone who is comfortable not initiating conversation when there is no functional need to do so.

A 2. Observed differences in non-verbal communicative behaviours used for social interaction; ranging for a preference for less eye contact, gestures and consistency in facial expression. This preference could be explained by discomfort, and/or lack of recognition or importance placed on this mode of communicating.

A 3. A preference for an autistic style of relationship which may place more emphasis on an autistic style of communication, such as sharing long strings of information based on personal interests or goals. As with a neurotypical presentation, an autistic style of communication is also consistent across social contexts. Mismatched communication/play styles could be misinterpreted as a lack of imagination or interest in other people.

B – A preference for a monotropic attentional style and resultant coping mechanisms to negotiate a predominantly polytropic world:

B1. A need for safety and predictability in a way that provides comfort in a world that does not validate the individual. This can include repetition in speech, movement and use of objects; commonly recognised as stimming.

B2. A need for safety and predictability in a way that provides comfort in a world that does not validate the individual. This can include autonomously planning predictable routines. The individual may experience increased anxiety when the world does not feel safe, becomes uncertain or when autonomy is not possible.

B3. A preference for a monotropic attentional style which may be observed as an increased passion or focus on an interest, hobby or objects which provide the individual with comfort and joy. Unexpected and sudden transitions away from these interests, hobbies or objects can lead to the individual experiencing intense distress and emotional dysregulation.

B4. Sensory seeking or avoidance based on personal sensory preferences. Exposure to unwanted sensory stimulation can be distressing or painful for the individual. Internal bodily signals may not be felt, or prioritised when engaged in a highly focussed activity.

C – Autistic preferences in social communication and monotropic attentional styles must have been present since early childhood, but these may not be as noticeable until mismatched communication styles are more prevalent in the young persons environment.

D- A neurotypical/polytropic world significantly disadvantages the individual.

The assessment tools used for diagnosis and research in the field of Autism have almost always been developed from research using predominantly male samples. Girls and women need to be struggling more than male peers to get a diagnosis, and it can take 6 years longer. A study looking at the Autistic Girls Network Facebook group found autistic women and girls waited much longer from the point of referral to the point of diagnosis, and the longest wait was 20 years! They also had a woman in her 80’s join the group who had just been diagnosed after she recognised herself in her newly diagnosed grandchild.

In the UK, there is a wide geographical difference in how likely girls are to be diagnosed. Some areas have a ratio of 1 girl to 30 boys, while others have a ratio of 1 girl to 2 boys. This is not just an anomaly, rather a difference in how diagnostic teams recognise autistic girls. There is research suggesting that more women are referred for diagnosis as adults than men, which implies that more girls are being missed.

The topic of Autism and girls has been much discussed in recent years, but while many are aware that autistic girls may present differently, there is widespread misunderstanding about exactly how. This is a huge issue because autistic girls (and those who present in the same way) are being missed and outcomes for autistic females are particularly poor.

Girls in the UK are still being diagnosed as autistic up to six years later than boys though. Given what we are coming to understand about the damage a late diagnosis and subsequent masking can do to an autistic person’s mental health, confidence and self-esteem, this is a statistic which needs to change fast. Girls are not diagnosed later because there is a female version of Autism! They are missed for complex reasons the largest of which is masking and Autism being misrepresented as a set of observable behaviours rather than an internal experience of the world.

Friendships can be very important to autistic girls and also cause a great deal of anxiety, especially if there is conflict. Autistic girls may be extremely sociable or chatty, or very shy and reserved. It is common for them to have one or two strong friendships, but struggle socialising in groups. This may not be obvious though, as they may have learned to mask their difficulties well. 

Interviews with autistic women identified that a common theme was to not really feel as if they fitted into the friendship group, and for the friendships to easily drift away or peter out in conflict. Others felt that they had more difficulty keeping friendships than making them in the first place, but however lonely they sometimes felt or however difficult the friendships became to navigate, all of these autistic women wanted friendships above all.

The Autistic Girls Network have a white paper on an internal presentation of Autism and why it is often missed. Click here to find it.

One common theme with autistic individuals, especially females, is the need to “mask” their differences (i.e. behave in ways which fit the accepted social norms of their peers or a given context even if this is contrary to how they would rather behave, or feel they need to behave, in order to “fit in”). The act of “masking” is often exhausting for autistic individuals and frequently results in anxiety becoming pent up, until the person feels they are in a safe enough space to release the pent-up anxiety.

At Cognition we often use the analogy that masking is a type of experience akin to a constant “first day at a new job syndrome”. When we start a new job we are often exhausted at the end of the day as we have been watching and figuring out what to say, how to act, and what to do all day in order to fit in with our new colleagues. As we get to know our surroundings and what to say and how to act become automatic this exhaustion abates and we feel more relaxed.

For an autistic person, negotiating the neurotypical social world is never easy thus it feels like the first day of a new job every single day! The more complicated the social demands on any given day the more exhausted the person will feel and the more likely it is thry will need to withdraw if the anxiety and exhaustion that result from their social experiences overwhelm them.

Traditional views of Autism have always focused on observable behaviours rather than considering that Autism is more about an internal experience of the world (we might only come to recognise someone is autistic when they are in distress as something about their environment is no longer working for them). What we mean by “observable behaviours” is that something noticeable to the majority of people where the person behaves in a way which makes them visibly different to their non-autistic peers. This may be a stim (a movement or making a noise in a repetitive way) by rocking or flapping their hands, or exhibiting distressed behaviour.

The observable behaviours conception of Autism is a generalisation, however as children brought up as girls “don’t tend” to present that way as much (but some do and if they do, they are probably diagnosed earlier). Their autistic traits (and those of some boys) are masked and internalised to help them fit in with their peers, which can be a conscious or unconscious decision to avoid the stigma of being autistic. However, masking comes with a high cost in terms of mental health and keeping a strong sense of identity, and it’s no coincidence that children and young people who present in an internal way are being diagnosed autistic at the time, and because, they have reached breaking point.

Thinking about Autism as an internal experience rather than an observable one can be extremely helpful and validating, especially for girls and women!