Post by Amanda Moses

There is an assumption floating around that neurodiversity-affirming assessment means focusing on strengths, affirming identity, and taking a lighter or less clinical approach. Neurodiversity-affirming assessment is grounded in understanding autism as a neurological profile. When this is taken seriously, the assessment task becomes more demanding, not less. If autism is a neurological profile, assessment cannot rely only on what is visible in the room or captured by checklist-style tools. Observable behaviour matters, but it represents only part of the picture. Neurodiversity-affirming assessment therefore requires depth. Quantitative measures are used, but not in isolation. Observable behaviour is attended to, alongside rich qualitative data. Assessment involves understanding the person’s subjective world, including sensory experience, cognitive style, social effort, and internal load. Information is gathered from multiple sources and across development to understand how this profile has shown up over time. There is no single assessment tool that can rule autism in or out on its own. Rigorous assessment involves synthesising data rather than outsourcing clinical judgement to measures. Affirming assessment also requires a solid understanding of masking and compensation, and of how autism can meet diagnostic criteria in ways that are not obvious or stereotyped. Finally, neurodiversity-affirming assessment relies heavily on research. This includes the literature on underdiagnosis, late diagnosis, masking, and the impacts of diagnostic overshadowing, which informs how information is interpreted in practice. This kind of assessment takes time. It requires high-level clinical skill, the ability to synthesise complexity, and careful reasoning. Given how our understanding of autism and diagnostic assessment has evolved, current best practice is more rigorous than earlier approaches. Looking back at how autism was historically diagnosed, it is evident that neurodiversity-affirming practice has raised the standard of assessment.