Autism Diagnostic Interview – Revised (ADI-R)
Assessment Report
Assessment report on:
Date of birth: XX.XX.XXXX
Date of assessment: XX.XX.XXXX (face to face / telephone interview)
Age on assessment date:
Information offered by:
Relationship to client:
Administered by:
INTRODUCTION
In order to clarify the diagnosis we carried out the Autism Diagnostic Interview (ADI-R)
with the kind help of XXX’s XXX. This is a semi-standardised interview with established
reliability and validity (Lord, Rutter and LeCouteur, 1994). The interview focuses
primarily on the key diagnostic characteristics specified in the ICD-10 (International
Classification of Diseases 10th Edition) and DSM-IV-R (Diagnostic and Statistical Manual
of Mental Disorders); namely those features concerned with developmental delays,
differences in reciprocal social interactions, language, communication and play and on
restricted and stereotyped behaviours and interests. Many items concentrate on the
age four to five year period. The difficulty using the interview with parents of older
children is their potential inability to recall behaviours that occurred many years ago.
This report should be considered as part of an overall assessment for Autism Spectrum
Disorder (ASD).
Report completed by Emma Woodhouse
Family Background
Siblings
Ag Details of any developmental /
Name DOB Sex Relationship
e mental health difficulties
Developmental Milestones
First words 9
Phrases 10
Walking 5
Toilet Training 6, 7, 8
Early Development & Initial Concerns 1,2,3,4, 86
Loss of Skills 11-28
Health (fits & hyperventilation) 84, 85
Education & Schooling
Type of Ages when attended
Name of school Additional support
school From To
2
Report completed by Emma Woodhouse
Qualitative Impairments in Communication
Overall level of language/Current communicative speech 30, 41
Comprehension of simple language 29
Using others’ body to communicate 31
Articulation/pronunciation/intonation/volume/rhythm, rate 32, 40
Pointing 42
Nodding 43
Shaking 44
Gestures 45
Attention to voice 46
Spontaneous Imitation of Actions 47
Imaginative Play 48
Imaginative Play w/ Peers 49
Imitative Social Play 61
Initiation of appropriate activities 60
Social Verbalisation 34
Reciprocal Conversation 35
Stereotyped Utterances 33
Neologisms 38
Pronominal Reversal 37
Socially inappropriate questions / statements 36
Qualitative Impairments in Reciprocal Social Interaction
Direct gaze 50
Social smiling 51
Range of facial expressions 57
Inapp facial expressions 58
Interest in children 62
Response to approaches of other children 63
Group Play 64
3
Report completed by Emma Woodhouse
Friendships 65
Showing/Directing Attention 52
Offering to share 53
Sharing Enjoyment 54
Offering Comfort 55
Qual of Social Overtures 56
Appropriateness of Social Response and Social Disinhibition 59. 66
Aggression 81, 82
Repetitive Behaviours & Stereotyped Patterns of Interest
Unusual Preoccupations 67
Circumscribed Interests 68
Verbal Rituals 39
Compulsions/Rituals 70
Difficulties with minor changes to routine and environment 70, 74, 75
Hand/finger mannerisms 77
Complex body mannerisms 78
Midline Hand Movements 79
Gait 80
Sensory seeking/aversions and unusual attachment to objects 71, 72, 73, 76
Repetitive / non-functional use of objects 69
Self Injury 83
Special Isolated Skills (88-93)
SUMMARY
Based on this assessment, XXX presents / does not present with a (clear) pattern of
qualitative differences in language communication, social interactions and
restrictive/repetitive interests & behaviours that we would expect to see in individuals
with an Autism Spectrum Condition.
4
Report completed by Emma Woodhouse
Alternative:
It was not possible to score the ADI-R, as XXX found it difficult to recall specific details
from the time between X’s 4th and 5th birthday. This often occurs when interviewing
parents of older children / adults. However, the information provided about X’s
development is (not) consistent with a diagnosis of Autism Spectrum Disorder.
This report should not be taken in isolation, as the ADI-R is one part of a comprehensive
assessment of Autism Spectrum Disorder. Further information about X’s social
interactions, communication skills and repetitive behaviours and stereotyped interests
should also be considered.
Report completed by:
