The limitations of online tests and online assessments for autism
09 Jun 2020
by The Autism Service

People are increasingly searching for terms like ‘online test’ and ‘online assessment’ when looking for a diagnostic assessment service.

An online ‘test’ is completely different from an online ‘assessment’. A ‘test’ is a screening questionnaire that tells you if you have signs or symptoms of autism, and if it would be worthwhile pursuing a formal assessment. It does not provide a diagnosis and it simplifies a complex developmental disorder, to the extent that it is likely to provide unhelpful information – i.e. it tells you that you have a high chance of having autism when you do not or vice versa.

At The Autism Service, we do not use tests or questionnaires to screen for autism for this very reason. They are just not sensitive enough and impact on client anxiety and expectations in an unhelpful way. We see no correlation between scores on these tests and the outcome of formal diagnostic assessments.

An online ‘assessment’ is different. It is a diagnostic assessment that is completed through the use of video technology. An interview may be completed and observation of the client and the outcome is a diagnosis or not.

We do not use video technology at The Autism Service to complete assessments, preferring to see our clients face-to-face, and there are several reasons for this.


What are the issues with online assessments?

Autism is a disorder of social communication and interaction. To diagnose it, you need to observe and assess how a person communicates and interacts.

Now, as soon as you put a video camera between two people – with or without autism – communication and interaction are distorted. The simplest example of this is eye contact. How can you assess eye contact when no one is sure where to look? In our opinion, you can’t.

The gold-standard tools that we have available to us, such as the ADOS-2, are also not validated for use online. So, you would have to use a home-made alternative – something that we think is unnecessary and not acceptable.

And there is the issue of patient experience. We want it to be positive – life is hard enough for our clients already – and the additional pressure and social demands created by use of a video camera only heighten anxiety. Which in turn affects social skills and further lessens the accuracy of the assessment.


What are the implications of online assessments?

With an improved public understanding of autism, we are receiving more enquiries from people who are questioning if a diagnosis they received previously from an online assessment is correct.

This is concerning – removing a diagnosis is distressing for all involved. We would, therefore, say that in the case of diagnosing autism, no assessment is better than an online assessment.