Professionals’ perspectives on neurodiversity-affirmative autism diagnostic assessment

Abstract

Autism diagnostic assessment for children and young people tends to focus on within-individual ‘deficits’ and non-autistic interpretation of observable behaviours. In contrast, a neurodiversity-affirmative assessment involves centring autistic perspectives, focusing on strengths, differences and needs, and acknowledging the role of the environment. The present study was designed to focus on professionals’ perspectives on neurodiversity-affirmative autism diagnostic assessment. Autism community stakeholders were consulted on the design of the interview schedule. Semi-structured interviews were conducted with 19 professionals aged 30 to 73 years who work in a multidisciplinary team within the United Kingdom. Reflexive thematic analysis was used to identify themes. Professionals described a holistic, balanced assessment involving assessing individual and contextual strengths and needs. According to professionals, assessing strengths could be beneficial for autistic children and young people's long-term wellbeing. Professionals also highlighted an autistic person-centred assessment and a strengths-and-needs-led, rather than diagnosis-led approach. These findings highlight the importance of a holistic, person-centred, strengths-and-needs-led assessment that has the potential to support autistic thriving. Lay abstract Autism diagnostic assessments tend to focus on difficulties within an individual. They also tend to focus on how people who aren't autistic interpret observable behaviours. It is important to take a neurodiversity-affirmative assessment approach. This involves focusing on what autistic people say. It also involves looking at strengths and needs and thinking about how the context a person is in may influence their experiences. We wanted to find out what professionals involved in autism diagnostic services think about neurodiversity-affirmative autism diagnostic assessment. We focused on services for children and young people. We asked autistic adults and parents/carers of autistic children to help us design our interview questions. We then interviewed 19 professionals who work in the United Kingdom. We used a qualitative method called reflexive thematic analysis to analyse the data. The professionals we interviewed described a holistic assessment which involves assessing the strengths and needs of the individual and the context a person is in. According to professionals, assessing strengths could benefit autistic children and young people's wellbeing in the long run. Professionals also discussed valuing the child's views in an autistic person-centred assessment. Our findings also emphasise an approach that focuses on strengths and needs rather than diagnosis.