Autism Spectrum Assessments
Neurodiversity-Affirming Autism Assessments
for Adults and Adolescents
Wondering if autism might help explain some of your experiences?
Maybe you have spent years feeling like certain things seem easier for other people than they do for you. Social situations may require significant effort, sensory experiences may feel overwhelming, or you may have learned to carefully observe, imitate, and adapt to the people around you. You may have wondered whether autism could provide a framework for understanding experiences you have had throughout your life.
An autism assessment can be an opportunity to explore those questions with curiosity rather than judgment.
The goal of an assessment is to better understand your experiences, identify strengths and support needs, and determine whether the available clinical information supports an autism diagnosis.
Autism assessments at Integrated Therapy Services NW are provided by:
Kristina Betz, LMFT, CAS, ASDCS, CMNCS.
At Integrated Therapy Services NW, autism assessments are grounded in a neurodiversity-affirming approach.
Autism is understood as a naturally occurring variation in human neurodevelopment, rather than something that needs to be cured or fixed.
Kristina provides assessments for adults and adolescents and primarily conducts evaluations through telehealth.
Find her full bio here.
A Different Approach to Autism Assessment
Autism does not look the same in every person.
Traditional approaches to autism assessment can sometimes place significant emphasis on observable behaviors during a structured appointment. While behavioral observation can provide useful information, it does not always capture what it takes for someone to function in everyday life.
Kristina’s approach looks beyond what is immediately visible.
Assessments explore developmental history, communication and relationships, sensory experiences, interests, routines, emotional regulation, and everyday functioning.
They also consider the ways someone may have learned to
navigate environments that do not naturally fit the way they experience the world.
This includes exploring masking, camouflaging, compensation,
and internal effort.
Someone may appear highly socially capable while expending substantial energy monitoring their behavior, interpreting social expectations, rehearsing conversations, copying others, or suppressing natural responses.
The purpose is not to determine whether someone can “look autistic” during an appointment.
The goal is to develop a comprehensive understanding of the individual’s experiences and determine whether autism provides a clinically meaningful explanation for them.
Why Might an Autism Diagnosis Be Helpful?
For some people, an autism diagnosis is not about putting a label on themselves. It is about finally having a framework that makes sense of experiences they have been trying to understand for years.
A diagnosis may help you make sense of things such as:
- Why social interaction can feel exhausting even when you appear socially confident
- Why sensory experiences affect you so strongly
- Why certain routines, interests, or ways of processing information are important to you
- Why you experience shutdowns, meltdowns, overwhelm, or burnout
- Why relationships or communication may sometimes feel harder than you expected
- Why previous diagnoses or explanations have never quite felt like the whole picture
- Why you have spent years feeling different without understanding why
- Why certain environments are significantly more difficult for you than others
- Why you have developed extensive strategies for adapting, masking, or compensating
For some people, receiving an autism diagnosis can provide language for experiences that previously felt confusing, frustrating, or disconnected.
It can also help identify accommodations, supports, and strategies that are better aligned with how they function.
For others, the assessment itself is valuable even when the outcome is not an autism diagnosis.
The process can provide a clearer understanding of strengths, challenges, patterns, and support needs.
Autism Assessment is not one-size-fits-all
One of the confusing things about seeking an autism evaluation in the United States is that there is
not one universally required autism assessment or single standardized assessment process that every clinician uses.
Autism is diagnosed clinically using the diagnostic criteria outlined in the DSM-5-TR, but clinicians may use different combinations of clinical interviews, developmental history, behavioral observation, standardized questionnaires, structured assessment tools, collateral information, and other sources of clinical information.
This means that two qualified clinicians may use somewhat different assessment approaches while still conducting legitimate clinical evaluations.
Some assessment tools were originally developed with children or specific clinical populations in mind and may not capture the experiences of every autistic person, particularly people who are highly verbal, have learned to mask or camouflage, or are seeking an evaluation later in life.
This is one reason Kristina’s assessment approach does not reduce autism assessment to a single score or a single appointment.
A Comprehensive Clinical Picture
Kristina brings together multiple sources of information rather than asking one assessment tool to answer the entire question.
Depending on the individual and assessment option, this may include:
- Developmental history
- Clinical interviews
- The MIGDAS-2
- Standardized self-report measures
- Behavioral observations
- Exploration of sensory and emotional experiences
- Masking and camouflaging
- Functional impact across environments
- Current and historical relationship experiences
- Optional collateral information
The goal is to understand the whole pattern of an individual’s experiences, not simply whether they demonstrate a particular behavior during a structured appointment.
Autistic characteristics can present differently across individuals, and the ways they are expressed can be influenced by age, gender, culture, environment, learned coping strategies, trauma, other neurodevelopmental or mental health experiences, and the degree to which someone has learned to mask.
An autism assessment should
leave room for that complexity.
What Does an Autism Assessment Look At?
An autism assessment considers the whole person rather than a single symptom or test score.
Depending on individual circumstances, Kristina may explore:
Developmental History
Early childhood experiences, communication, play, relationships, routines, interests, sensory experiences, and patterns of development.
Social Communication and Relationships
How you experience social interaction, communication, friendships, romantic relationships, group settings, and unspoken social expectations.
Interests and Patterns
Focused interests, routines, predictability, repetitive behaviors, patterns of thinking, and ways you organize or engage with information.
Emotional Regulation and Nervous System Experiences
Overwhelm, shutdowns, meltdowns, burnout, recovery time, and the internal effort involved in navigating everyday environments.
Functional Impact
How these experiences affect relationships, school, work, home life, daily activities, and your ability to sustain your wellbeing across different environments.
Sensory Experiences
Sensitivity or seeking related to sound, light, touch, movement, textures, smells, temperature, body sensations, and other forms of sensory input.
Masking and Camouflaging
Strategies you may have developed to fit in, manage expectations, imitate others, suppress natural responses, or appear more socially comfortable than you actually feel.
Strengths and Adaptations
The skills, interests, coping strategies, relationships, and environmental supports that have helped you navigate the world.
What Is the Assessment Process Like?
The assessment process is collaborative and individualized.
Rather than thinking of the process as completing a test and waiting for a result,
the evaluation involves gathering and integrating information from several sources.
Clinical Interview and Assessment
The clinical interview is a major part of the assessment.
Kristina will have a collaborative conversation with you about your developmental history, current experiences, communication, relationships, sensory experiences, routines, interests, emotional regulation, and everyday functioning.
The assessment may also explore experiences that are less visible to other people,
including masking, camouflaging, compensatory strategies, internal effort, exhaustion, and burnout.
Depending on the assessment option and individual needs,
standardized self-report measures and structured assessment approaches may also be incorporated.
There are no “right” or “wrong” answers.
Authentic responses, uncertainty, differences in how you experience situations, and the ways your experiences have changed over time can all provide meaningful clinical information.
Clinical Integration
Information gathered throughout the evaluation is considered together.
This may include:
Clinical interviews
Developmental history
Self-report measures
The MIGDAS-2
Behavioral observations through telehealth
Functional impact across different environments
Information about masking and compensatory strategies
Optional collateral information, when appropriate
No single questionnaire, observation,
or assessment determines the outcome.
Clinical conclusions are based on the totality of the information gathered and are considered within the diagnostic criteria outlined in the DSM-5-TR.
Feedback
Your final appointment is an opportunity to review the findings together.
Kristina will discuss the clinical impression, what the findings may mean for you, areas of strength and support needs,
and recommendations or resources that may be helpful.
The goal is not simply to hand you a report.
Feedback is an opportunity to ask questions, process what you have learned, and consider how the information may apply to your life,
relationships, work, school, or ongoing therapy
What About the ADOS-2?
The ADOS-2 is a commonly known autism assessment tool, but it is not the assessment tool used in Kristina’s evaluations.
Instead, autism assessments may incorporate the MIGDAS-2 (Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition) as part of a broader clinical evaluation.
The MIGDAS-2 provides a structured, narrative-based framework for exploring autistic characteristics, sensory experiences, communication and social experiences, interests, relationships, and the ways a person experiences and navigates the world.
Kristina uses the MIGDAS-2 alongside clinical interviews, developmental history, behavioral observation, self-report measures when appropriate,
and exploration of functional impact across settings.
This allows the evaluation to consider multiple sources of information rather than relying on performance during a single structured assessment.
This can be particularly important when working with adults and adolescents who may have learned to consciously or unconsciously mask, camouflage, or compensate for autistic traits.
Someone may appear highly socially capable during a structured assessment while experiencing significant internal effort, sensory overwhelm, exhaustion, or difficulty navigating everyday environments.
The MIGDAS-2 is one component of the evaluation rather than a stand-alone test.
There is no single test that determines whether someone is autistic.
Clinical formulation is based on the totality of the information gathered throughout the assessment.
Masking, Camouflaging, and Late Identification
Many people, particularly those who are diagnosed later in life, have developed sophisticated ways of adapting to
social and environmental expectations.
Masking or camouflaging can include consciously or unconsciously:
- Studying and copying other people’s social behavior
- Rehearsing conversations or responses
- Monitoring facial expressions, eye contact, tone, or body language
- Suppressing sensory or repetitive behaviors
- Hiding confusion about social expectations
- Pushing through sensory discomfort
- Using learned scripts for social situations
- Relying heavily on routines or preparation to manage uncertainty
These strategies can make autistic characteristics
less obvious during an assessment while requiring substantial internal effort
For this reason,
Kristina’s evaluation considers not only what other people observe, but also what it takes for you to function in your everyday life.
Can Someone Be Autistic and Have Other Diagnoses?
Yes.
Autism can occur alongside many other mental health or neurodevelopmental conditions.
Having another diagnosis does not automatically rule out autism, and autism may sometimes help explain experiences that have not been fully understood through previous diagnoses.
The assessment considers the broader clinical picture, including how different experiences may overlap, interact,
or be better explained by another condition.
The goal is not to collect diagnoses. It is to develop an accurate and useful understanding of your experiences.
Can Someone Else Participate in My Assessment?
Yes!
With your written permission, a partner, family member, or another person who knows you well may provide
additional developmental or current-life information.
Collateral information can be particularly helpful when exploring childhood development or understanding how
experiences appear across different environments.
Collateral participation is optional and does not replace your own experience or self-report.
You will determine who may participate and what information may be shared.
Additional time for collateral interviews is billed at $150 per hour.
Two Assessment Options
Informal Autism Assessment — $700
The Informal Autism Assessment is designed primarily for personal understanding, self-exploration, psychoeducation, and therapeutic insight.
It includes:
- One 50-minute assessment appointment
- One 50-minute feedback appointment
- One-page summary letter
- Personalized resources and referrals
- Psychoeducation to support self-understanding and therapeutic work
This option does not include standardized screening measures, formal diagnostic testing, or an accommodation request letter.
Formal Autism Assessment — $1,200
The Formal Autism Assessment is intended for individuals seeking a more comprehensive clinical evaluation and written documentation.
It includes:
- Two 50-minute in-depth assessment appointments
- Review and integration of appropriate self-report screening measures
- MIGDAS-2 as clinically appropriate
- One 50-minute feedback appointment
- Comprehensive written diagnostic report
- Personalized resources and referrals
- Accommodation request letter when clinically appropriate
Additional assessment time, when needed, is $150 per hour.
What Can an Autism Assessment Be Used For?
An autism assessment and diagnostic report may be useful for a variety of purposes, depending on your individual needs.
This may include:
- Personal understanding and self-exploration
- Individualized treatment planning
- Accessing services and supports
- College or university accommodations
- Workplace accommodations
- School-based supports and accommodation requests
- 504 or IEP-related requests
- Disability-related benefits or documentation, including SSI or SSDI
- Providing diagnostic information to medical or mental health providers
- Supporting conversations about medication management, when appropriate and at the discretion of a prescribing provider
Every Organization Has Different Requirements
Requirements for autism documentation vary by organization.
Schools and school districts, colleges and universities, employers, government agencies, disability programs, medical providers, insurance companies, and other organizations may each have different requirements regarding:
- Who can complete an evaluation
- What credentials the provider must have
- What information must be included in the report
- How recent the evaluation must be
- Whether specific assessment tools are required
- Whether additional testing or documentation is needed
Because these requirements vary, it is important to contact the organization you plan to submit your documentation to before beginning an assessment and ask exactly what they require.
The responsibility for confirming that an assessment meets an organization’s specific requirements rests with the individual requesting the documentation.
If an organization requires a particular type of evaluation,
provider credential, testing instrument, or documentation that falls outside the scope of this assessment,
a different or additional evaluation may be necessary.
What This Assessment Does Not Provide
This is a clinical autism assessment conducted by a Washington State Licensed Marriage and Family Therapist.
It is not a psychological or neuropsychological evaluation.
The assessment does not include:
- Neuropsychological testing
- IQ testing
- Educational achievement testing
- ADOS-2 administration
- Other testing that falls outside the scope of a clinical autism evaluation
This does not necessarily mean that the resulting documentation cannot be used for a particular purpose.
Whether documentation is accepted is determined by the organization requesting it.
If you are seeking an evaluation for a specific purpose, such as school accommodations, workplace accommodations, disability benefits, medical documentation, or another service, please contact that organization before scheduling to determine what they require.
Telehealth Autism Assessments
Autism assessments are primarily provided through telehealth
Telehealth can provide a comfortable and accessible environment for many clients and may allow people to participate from a familiar setting rather than navigating an unfamiliar clinical environment.
At the same time, telehealth has limitations. Certain nonverbal behaviors and environmental experiences may be more difficult to observe remotely, and the assessment relies significantly on self-report and narrative information.
These limitations are considered as part of the evaluation.
In-person assessment may be available on a case-by-case basis when clinically appropriate.
Private Pay and Insurance
Autism assessments are private pay services and are not billed to insurance.
A superbill may be provided upon request, but reimbursement is not guaranteed and is determined by your insurance carrier.
Many insurance plans do not reimburse autism evaluations completed by LMFTs, particularly when the evaluation is provided through telehealth.
You are responsible for the assessment fee regardless of whether your insurance company provides reimbursement.
Please contact your insurance provider directly if you are considering submitting a superbill.
Getting Started
There are two ways to begin.
Option 1: 15-Minute Consultation — Free
A brief, no-cost conversation to talk about what you are looking for, ask initial questions, and determine whether an autism assessment with Kristina may be a good fit.
You do not need to know which assessment option you want before scheduling a consultation.
Option 2: 50-Minute Intake — Billed Through Insurance
You may also begin with a full 50-minute clinical intake, which may be billed through insurance.
Before scheduling, please visit the Insurance page to determine whether your insurance plan is accepted.
During the intake, you can discuss your concerns, history, goals, and what you are hoping to understand through an autism assessment. This also gives Kristina an opportunity to determine whether an assessment is appropriate and which assessment option best fits your needs.
If you are unsure where to start, the free 15-minute consultation is a good place to begin.
Ready to Explore Whether Autism May Fit Your Experience?
You do not have to have everything figured out before reaching out.
Whether you have been wondering about autism for years or are only beginning to consider whether it might explain some of your experiences,
an initial conversation can be a place to start.
You can schedule a free 15-minute consultation with Kristina Betz, LMFT, CAS, ASDCS, CMNCS to discuss your questions and determine
whether an assessment may be a good fit.
You may also schedule a 50-minute intake, which may be billed through insurance.
Visit the Insurance page first to determine whether your plan is accepted.
The goal is not simply to answer, “Am I autistic?”
It is to better understand how you experience yourself, your relationships, and the world around you—and what support may help you
live in a way that feels more sustainable and authentic.
Frequently Asked Questions
A referral is not required to request an autism assessment.
You can discuss your concerns during a consultation or intake and determine whether an assessment is appropriate.
No.
You do not need to be certain that autism is the explanation for your experiences.
The purpose of an assessment is to explore that question clinically.
You are welcome to bring those results to the assessment.
Online questionnaires can provide useful information about your experiences, but they do not independently establish an autism diagnosis.
That is okay.
Collateral information is optional. Your assessment does not require a family member, partner, or other person to participate.
Masking is specifically considered during the assessment.
The fact that you can appear socially capable does not, by itself, rule out autism.
Yes.
The assessment process can help identify patterns in communication, sensory experiences, emotional regulation, relationships, and daily functioning that may be useful for treatment and self-understanding regardless of the final diagnostic conclusion.
No.
The purpose of the evaluation is to determine whether the available clinical information supports an autism diagnosis.
Conclusions are based on the full assessment rather than a predetermined outcome.
That depends on the organization.
Different schools, school districts, colleges, employers, government agencies, medical providers, and other organizations may have different requirements for autism documentation.
Before beginning an assessment for a specific purpose, contact the organization requesting the documentation and ask what they require