Autistic adults’ perspectives and experiences of diagnostic assessments that include play across the lifespan

Abstract

Play is often included in autism diagnostic assessments. These tend to focus on ‘deficits’ and non-autistic interpretation of observable behaviours. In contrast, a neurodiversity-affirmative assessment approach involves centring autistic perspectives and focusing on strengths, differences and needs. Accordingly, this study was designed to focus on autistic perspectives of diagnostic assessments that incorporate play. Autism community stakeholders were consulted on the design of the study. Semi-structured interviews were conducted with 22 autistic adults aged 18–57 years who live in the United Kingdom. Interpretative phenomenological analysis was used to identify themes. Autistic adults highlighted the varying ways in which play was included in their diagnostic assessments, such as via the Autism Diagnostic Observation Schedule. Our findings highlight the importance of better adapting assessment to the heterogeneity of autism. For example, our findings question the extent to which play is useful for assessing autistic women and girls who mask. Our findings also suggest that holistic, neurodiversity-affirmative assessment practices should be adopted. Our findings support the importance of adopting a personalised approach to diagnostic assessments that use play, in addition to assessing strengths and differences as well as needs. Lay abstract Play is often included in autism diagnostic assessments. These assessments tend to focus on negatives and how people who are not autistic interpret observable behaviours. It is important to take a neurodiversity-affirmative assessment approach. This involves focusing on what autistic people say and looking at strengths and needs. We wanted to find out how autistic adults experience diagnostic assessments that include play. We asked autistic and non-autistic people to help us design our study and interview questions. We then interviewed 22 autistic adults to find out what they think about the use of play in assessments. We used a qualitative method called interpretative phenomenological analysis to analyse the data. Autistic adults told us about the different ways play was included in their diagnostic assessments. For example, some completed a diagnostic tool called the Autism Diagnostic Observation Schedule. Autistic adults also talked about the importance of considering how autistic people are different to each other. For example, we found that play may not be useful for assessing women or girls who mask. This suggests that professionals should adopt a personalised approach to diagnostic assessments that use play catering to each person’s needs. Our findings also suggested that professionals should assess strengths and differences as well as needs.